Under the general supervision of the Financial Specialist II (FSII), this position supports the Fiscal Team of the Fairfax-Falls Church Community Services Board (CSB). This position plays a vital role on the Revenue Management Team, which manages billing, collections, tracking, and reporting for approximately $30 million in client and third-party fee revenues.
Duties include responsibility for third party reimbursement functions and monitoring revenue cycle activities to analyze denial data and resolve issues. Works directly with insurance payers to determine reasons for denials, identify trends, and collaborate with all stakeholders to resolve denial matters. Conducts research on rejected claims to determine root causes, proposes solutions, and implements corrective actions. Leads communication with all parties to confirm denial details and files appeal by gathering and providing supporting documentation extracted from the electronic health records (EHR) system. Superior knowledge of timely filing requirements for each payer, the ability to address related issues, and strong prioritization skills are essential.
Coordinates “no authorization” denials in collaboration with the Utilization Management Team (UMT) to obtain necessary updates, independently and proactively runs status reports on claims requiring authorization and works with UMT staff for resolution. Conducts research on denials related to ineligible providers and collaborates with Contracts and Credentialing staff to resolve them. It periodically plans actions to adjust non recoverable claims and makes recommendations to reduce denials and enhance fee revenue.
Directs the process of generating automated payment reports and audits and reconciles payments to both manual and system generated documents to ensure accuracy in payment posting. The position is responsible for follow up on daily post processing activities, including re-issuing denied claim statements. Collaborates with insurance companies to resolve pending issues and shares findings with the supervisor, and leads communication with department contacts regarding accounting errors, billing issues, and necessary modifications. Responsible for timely overpayment correspondence to ensure compliance with applicable policies.
Demonstrates appropriate knowledge of ICD 10, CPT, and HCPCS coding systems, as well as claim forms CMS 1500 and UB 04. Receives and evaluates billing requirements from the clearinghouse vendor, implements necessary changes, and disseminates relevant information. demonstrates initiative and the knowledge needed to research, understand, and resolve complex financial issues and is able to handle confidential and sensitive information.
As a senior account representative, works directly with clinical staff and third-party payers to maximize revenue for CSB services. Develops procedures and implements processes to adapt to changing requirements of third-party payers and maintains knowledge of payer specific regulations and guidelines. Attends statewide conferences, local trainings, webinars, and other meetings to stay abreast of industry standards. Works with the DAHS PR Business Analyst and CSB Informatics staff to maintain EHR system settings that support efficient and effective billing and helps create and monitor productivity reports for use by Revenue Management Team staff, senior managers, and clinical staff.
In collaboration with the FSII, manages and directs administrative staff responsible for third party reimbursement functions. The position manages and directs Administrative Assistant IVs in collaboration with the third-party team supervisor, leads efforts to develop performance standards and goals, and assesses performance on an ongoing basis, including annual pay for performance evaluations. Periodically reviews position descriptions and updates them as needed, participates in the hiring process by serving on interview panels, and makes recommendations for new hires to the supervisor.
The ideal candidate will demonstrate excellent customer service skills with the ability to interact in a friendly, service-oriented, and professional manner with internal and external customers. Will be able to work both independently and as part of a team; be proactive; exercise good judgment; and apply strong critical thinking skills. Strong verbal and written communication skills are required, as well as advanced proficiency with Microsoft Excel (including PivotTables), Outlook, and Word. Must also be able to work with limited supervision, set priorities, and manage multiple tasks simultaneously.
Functional areas: general administrative, medical or insurance billing, or finance
Note: To learn more about careers that make a difference, watch our video "CSB Celebrates 50th Anniversary of Providing Care."
(The knowledge, skills and abilities listed in this specification are representative of the class but are not an all-inclusive list.)
Knowledge of county policies within functional area of responsibility. This may include knowledge of an outside institution, dissimilar operational unit within the county or the basic principles and methods of a professional field.
Executive Assistance
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Thorough knowledge of the executive/work unit head's program/area and of county administration and organization.
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Ability to maintain confidentiality and be sensitive to political issues.
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Knowledge and sensitivity to issues, priorities, protocol, etc.
Math Skills
PC Skills-
Intermediate skills in the use of applicable Microsoft Office Suite software;
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Intermediate skills in the use of agency specific software applications.
Communication-
Ability to communicate well through written and oral means;
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Ability to speak in front of a group.
Information Abilities-
Ability to gather, integrate, and analyze complex data.
Interpersonal Abilities-
Ability to establish and maintain effective working relationships with both external and internal contacts.
MINIMUM QUALIFICATIONS:
Any combination of education, experience and training equivalent to high school graduation and four years of experience providing administrative support in the assigned functional area(s).
NECESSARY SPECIAL REQUIREMENTS:
The appointee to this position will be required to complete a criminal background check, a Child Protective Services Registry check, and sanction screening to the satisfaction of the employer. A TB screening upon hire.
PREFERRED QUALIFICATIONS:
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Experience with and understanding of Generally Accepted Accounting Principles (GAAP).
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Experience in revenue cycle management, including handling insurance claims, payment postings, insurance follow-up, and denial and appeals processes.
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Experience using billing systems and electronic health record (EHR) platforms, including effective navigation of payer portals and documentation in the EHR that is professional, appropriate, accurate, and meets departmental quality standards.
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Experience interpreting and making decisions based on policies and procedures.
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Supervisory experience, including planning, organizing, coordinating, assigning, and evaluating the work of staff.
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Experience planning, organizing, coordinating, assigning, and evaluating the work of staff.
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Demonstrated experience resolving complex problems in a team-based environment, balancing multiple priorities, and making presentations to senior managers and groups.
PHYSICAL REQUIREMENTS:
The work is generally sedentary and is usually performed in an office environment. Make presentations and communicate clearly and concisely, both orally and in writing. All duties performed with or without reasonable accommodations.
SELECTION PROCEDURE:
Panel Interview and may include a practical exercise.
Fairfax County is home to a highly diverse population, with a significant number of residents speaking languages other than English at home — including Spanish, Asian/Pacific Islander, Indo-European, and many others. We encourage candidates who are bilingual in English and another language to apply for this opportunity.
Fairfax County Government prohibits discrimination on the basis of race, color, religion, national origin, sex, pregnancy, childbirth or related medical conditions, age, marital status, disability, sexual orientation, gender identity, genetics, political affiliation, or military status in the recruitment, selection, and hiring of its workforce.
Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. TTY 703-222-7314.
[email protected] EEO/AA/TTY.
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