Reconsideration and Billing Support Manager

Tampa
Posted 2 months ago
Foresight Medical, a member of the Paradigm Family of Companies, is seeking a Reconsideration and Billing Support Manager. ForeSight Medical is a cost containment company that is dedicated to surgical implant claims in the workers compensation space. ForeSight combines unparalleled experience with analytics and a proprietary Implant Management Platform (branded Fusion) to objectively and defensibly reduce the cost of surgical implants.  The primary services offered by ForeSight are surgical implant bill review and claim payment negotiations. The Appeal and Reconsideration Manager is a shared service role for ForeSight Medical, LLC and Encompass Specialty Network, LLC and is responsible for day-to-day management of the ForeSight Reconsideration Team and EPS reconsiderations, coordinating responses for state-level provider disputes with external counsel when applicable, workers’ compensation regulation and state fee schedule research, and providing billing support. Essential Functions: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Provides day-to-day management of reconsideration staff, ensuring departmental processes are followed, timely communication occurs with providers and clients, and client requirements are met.
  • Acts as a liaison between external counsel, coordinates written responses and provides supporting evidence regarding state-level provider disputes.
  • Assists in researching and documenting workers’ compensation and state fee schedule regulations.
  • Acts as a shared service for ForeSight’s subsidiary, Encompass by providing billing knowledge support
  • Writes and administers performance reviews for skill improvement.
  • Is available for employees who experience work and/or personal problems providing appropriate coaching, counseling, direction and resolution.
  • Creates and maintains a high-quality work environment so team members are motivated to perform at their highest level.
  • Addresses disciplinary and/or performance problems according to company policy.
  • Shares continual responsibility for deciding how to manage the employees, ensuring all aspects of the operational flow are handled efficiently and effectively.
  • Works closely with the Senior Director of Compliance to assist in establishing departmental procedures and processes that support the company and departmental standards and strategic directives.
  • Uses appropriate judgment in upward communication regarding department or employee concerns.
  •  Understand & comply with all HIPAA & SOC2 requirements necessary in working with designated PHI.
  •  Perform additional support functions/roles on initiatives or projects as needed.
Requirements
  •  Communication Proficiency.
  •  Customer/Client Focus.
  •  Leadership.
  •  Organizational Skills.
  •  Performance Management.
  •  Problem Solving/Analysis.
  •  Technical Capacity.
  Supervisory Responsibility  
  • This position manages all employees of the department and is responsible for the performance management and hiring of the employees within that department.
  Work Environment  
  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
  Physical Demands  
  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
  • While performing the duties of this job, the employee is regularly required to talk and hear. The employee is frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee must be able to lift a minimum of 10lbs.
Position Type and Expected Hours of Work  
  • This is a full-time position. Days and hours of work vary between Monday through Friday, 7:30 am to 6:00 pm. Occasional evening and weekend work may be required as job duties demand.
  Travel
  • No travel is expected for this position.
  Required Education and Experience  
  •  Associate degree or equivalent number of years’ experience.
  •  Minimum typing speed of 45 WPM.
  Preferred Education and Experience  
  •  Customer service experience in a call center or client interfacing setting.
  •  Extensive knowledge in workers’ compensation and Medicare medical billing, terminology & surgical implants.
  •  Experience in managing with a small team
  •  Experience in appeals and reconsiderations processing
  Other Duties  
  • Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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