Position: Manager, Billing
Job Location: 2608 SE J Street, Bentonville, AR 72712
Duties: Researches complex bill review data to identify trends and implement best practices by running and analyzing reports ; determining root causes of increased charges or payment allowances; determining solutions to negative trends; maximizing benefits of positive trends; evaluating performance metrics (for example, reconsideration logs, savings dashboard); partnering with other teams (for example, analytics, senior coordinators, case managers, medical providers, defense counsel, regulatory agencies); and developing and maintaining workflow processes to ensure accurate implementation. Coordinates, completes, and oversees job-related activities and assignments by developing and maintaining relationships with key stakeholders; supporting plans and initiatives to meet customer and business needs; identifying and communicating goals and objectives; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; and demonstrating adaptability and promoting continuous learning. Ensures compliance with laws and regulations by researching changes to federal, state, and local laws and regulations impacting insurance payment of medical bills; ensuring changes in state reporting requirements, periodic fee schedules, and applicable laws and regulations are applied to bill review process and procedures; evaluating auditing results to ensure the audit forms measure the desired quality results ; modifying the auditing process as regulatory agency requirements change; building and maintaining relationships with other bill processing teams, state agencies, the Legal department, and bill review suppliers to clarify regulations or implement systematic changes required for compliance; evaluating vendor processors quality audit results, providing feedback on results to vendor processors, and creating action plans to correct deficiencies; and ensuring regulatory certifications for state and federal utilization and bill review are obtained. Manages vendor contracts by holding vendors accountable for delivering contracted services; ensuring contract language meets business and compliance requirements; monitoring workflow and changing it to meet vendor requirements to obtain discounted services; and ensuring claims team complies with contract requirements. Providing supporting information and education related to litigation of bill review to defense counsel; analyzing bill review litigation trends with adjusting teams and Legal department to develop solutions for implementation; collaborating with third party administrators to improve processes ; drafting letters and developing explanation of review statements for multiple states; educating team and vendor processors on pre-litigation best practices; and participating and leading special projects to enhance bill payment processes. Manages customer service and vendor call centers by reviewing reports on call time averages to make sure calls are processed efficiently and effectively; ensuring responses to inquiries regarding pharmacy and medical billing from internal and external stakeholders; and identifying and resolving global trends on escalated issues (for example, unprocessed hospital bill complaints).
Minimum education and experience required: Master's degree or the equivalent in Business Management, Accounting, Project Management, Healthcare Management or related field; OR Bachelor's degree or the equivalent in Business Management, Accounting, Project Management, Healthcare Management, or related field plus 1 year of experience in insurance claims, accounting, or related area.
Skills required: Must have experience with: Creating SQL queries using Google BigQuery; Analyzing large data sets using Advanced Excel; Contract Review/Contract Management; Data Reporting/ Generating data summaries or findings; Root Cause Analysis - Identifying issues and resolving variances; Collaborating with internal and external teams; Delivering support for the business by managing ad hoc assignments; Project Management using tools including Jira, Microsoft Teams, Microsoft Excel and Microsoft Word for project planning and documentation; Financial concepts including financial data, statements and invoices; Continuous Process Improvement; Problem Handling/Problem Management –Possess knowledge of Problem reporting & escalation procedures. Employer will accept any amount of experience with the required skills.
Wal-Mart is an Equal Opportunity Employer.
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