Supervisor, Revenue Cycle Audits - Authorizations

The Supervisor, Revenue Cycle Audits (RCA) will supervise the authorizations focus area and is responsible for profiling, researching, and resolving reimbursement issues for assigned payors, products, lines of business, and other variables as well as leading a team of both onshore and offshore auditors. The RCA Supervisor reports directly to one of the Manager in Revenue Cycle Audits. This role involves a mix of leadership, analytical, and quality responsibilities such as overseeing audit work and filling in as needed, identifying trends & issues, and providing insights and opportunities for improvement. They will also draw logical conclusions, provide actionable recommendations, and create data-driven forecasts from implementing strategies that can improve business performance, which they will then share with leaders.

PRIMARY RESPONSIBILITIES:

Mentoring/Coaching
● Exemplify a culture of empathy, high performance, and accountability and serve as a coach and
mentor to the team
● Perform ATA (Audit the Auditor) process to ensure quality and provide feedback to audit team
● Supervises, trains, provides work direction, and problem-solving assistance for audit team as well
as overseeing the daily operations of other staff
● Ability to present and communicate detailed information to stakeholders
Auditing/Quality Assurance
● Perform detailed and comprehensive audits on accounts to ensure steps within the billing lifecycle
are conducted accurately and according to industry best practices
● Assist with tracking QA results and quality SLA reporting
● Assist with developing and maintaining a robust quality assurance process
● Provide detailed audit results to operational leaders to help drive accountability, identify areas for
remedial education, and process improvement
Accounts Receivable Management
● Analyze and review complex accounts to investigate and determine root cause of AR issues
● Assist with the development and implementation of best practice workflows and
processes to ensure timely collections and effective denial management
● Work with Billing Strategy Directors and Product Managers to formulate a plan to
improve revenue per case by owning projects related to billing lifecycle such as demographics,
eligibility verification, pre-authorization, coding, claims management, payment posting, denials
management, AR management, patient statements/billing, etc
Process Improvement
● Consistently seek opportunities within billing lifecycle to enhance efficiency and accuracy in both

● Work cross-functionally within operations to help streamline billing lifecycle with AR reduction
strategies (i.e., mitigate denials) leveraging industry best practices
Reporting and Analysis
● Conduct thorough analysis for clarity of data to identify trends, potential issues, root cause, and
opportunities for improvement
● Assist with creating detailed monthly SLA and KPI reporting to track department
progress

Areas of Focus

The Revenue Cycle Audits Supervisor will be assigned a specific area within the revenue cycle
audits—such as demographic/data capture, eligibility verification, pre-authorization, coding, claims
management, payment posting, accounts receivable (AR), patient billing, etc. This focused assignment will
enable the Supervisor to gain specialized knowledge and insights into the intricacies of their designated area, leading to more effective auditing and process improvement.
In this focus area of the role, the RCA Supervisor will:
● Develop expertise in the assigned focus area, understanding its unique challenges and best
practices.
● Conduct targeted audits and quality assurance activities specific to their area, ensuring compliance,
accuracy, and process adherence.
● Collaborate with cross-functional teams to address issues, implement improvements, and drive
operational efficiency in their area.
● Identify trends and root causes within the assigned area that impact reimbursement, denial rates,
and revenue optimization.
● Create detailed reports that analyze the performance of their focus area, providing actionable
insights and recommendations to senior leadership.
● Lead continuous improvement efforts within their area by staying up-to-date on industry standards
and integrating best practices into workflows.

QUALIFICATIONS:

Required
● Bachelor's Degree in a healthcare related field of study or equivalent experience
● Minimum of 3 years of experience in supervising/management
● Minimum of 3 years of experience in auditing, medical billing, insurance collections, and dispute
resolution
Preferred
● Minimum of 5 years of experience in revenue cycle or claim analysis

KNOWLEDGE, SKILLS, AND ABILITIES:

Provide a list of technical or behavioral knowledge, skills, and/or abilities.
Technical: Evaluates an applicant's acquired knowledge and specific technical skills.
Behavioral: Evaluates factors related to human characteristics and skills, such as attitude, work approach and
collaborative abilities.
● Salesforce, AMD, EPIC (or other EHR/EMR system experience), PowerBI, Google Platforms, SQL
● Experience with lab billing preferred
● Project management experience preferred
● Knowledge of CPT/HCPCS, ICD-10, modifier selection, etc.

PHYSICAL DEMANDS &WORK ENVIRONMENT:

● This position requires the ability to use a computer keyboard, communicate over the telephone
and read printed material.
● Duties may require working outside normal working hours (evenings and weekends) at times.