Wiki Realistic Expectations

[sinman0531]

Hello!

Just looking for a little bit of input here, if I'm being unrealistic or my manager is.

I bill for a series of LTC facilities. Currently, we have +/-750 residents across 20 facilities with some type of Medicare/Medicaid. In other positions I have been in, anywhere from 95%-98% QA (aka clean claims) was expected, and anything above was gravy. In my current position, my manager expects 100%. Period. No errors, ever. Now, I have been working here for over a year, so of the literal thousands of claims I have submitted, I could keep a list on one single-sided page the errors I have made. I generally know as soon as I submit them it was an error, so I'm on the lookout for them and correct them as soon as we receive payment. On top of no errors, my manager expects me to bill these roughly 750 claims (a resident can have multiple claims) within 48 hours of being notified I can bill.

My manager is using the fact that I usually take 3-4 days to bill, and the fact that a claim might come back with an error every now and again, as an excuse to actively keep me from moving up within the company. I'm not overthinking, she has told me this. Although she is my manager, her experience is on the *private* side of billing, like for independent living situations or private duty nursing. We have no billing software (its an Excel spreadsheet), which contributes to the errors that are made--everything I do for the insurance side is manual, and my human brain makes mistakes. How can I explain to her that, based on my experience in this industry and the department limitations, her expectations are not based on real-life?

 

[SharonCollachi]

I don't think you're going to change her mind. What did the previous person do that moved up? Why won't they purchase software to actually bill the claims?

 

[sinman0531]

I don't think you're going to change her mind. What did the previous person do that moved up? Why won't they purchase software to actually bill the claims?

We have one person who has been with the company for like seven years? When she first started she did the billing by herself, but they were still using paper claims for the majority of the payors. She has said she is not familiar with most of the online billing portals for our payors, which is why I do it. She does all of the financial reporting/trend reports for our CFO, so high-level stuff.

I am actually the 3rd person in this position in 3-4 years. The first person, "Jennifer" we'll call her, moved on because unless you want to move into LTC/SNF administration, there's nowhere to go within this company. She was with them for almost 2 years I think. The second person, who was with them like 8 months or less, was TERRIBLE according to my manager and the other person in my department. So I know I'm not that bad cause she got fired LOL. Then there were some temps that came and went, and now I've been here for almost 14 months.

Essentially, we don't get software because we're not important. I bill/my department generates maybe half a million per month, but the private side is something like 2-3 million per month; so *they* have the accounting and billing software, and we have to manually enter all of the money we receive, as well as various adjustments and credits for each resident. Then we keep track of them in Excel so we know which months are paid and which are still outstanding, if they were denied and why, etc.