Team Lead, Reimbursement Specialist

Summary

PRIMARY FUNCTION

The Reimbursement Specialist Team Leader is responsible for the management and completion of special projects for contracted and non-contracted carriers. The team leader will also support and collaborate with department supervisor and manager to ensure the daily functions of the department are met.

SUPERVISORY RESPONSIBILITIES: None

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

1. Oversee, train, and provide resources for staff. Supports staff in reference to contracted and/or non-contracted carrier questions and monitors staff productivity and quality of work. Identifies performance gaps and escalates concerns to management. Assists management in implementing performance training and development programs and initiatives.

1. Monitors and completes adjustments to ensure accounts reflect proper balance.

1. Monitors Issues Tracking Logs and recommends prioritization based on volume and financial impact.

1. Researches assigned contracted and/or non-contracted carrier accounts to ensure the proper payment of claims through reports, spreadsheets and special projects as deemed necessary.

1. Identifies and corrects any claim processing (data entry, verification, coding and/or posting) errors.

1. Keeps manager and/or supervisor abreast of any changes in reimbursement that may affect initial billing procedures.

7. Works closely with supervisor and manager on Accounts Receivable projects

PERFORMANCE REQUIREMENTS:

Adhere to all organizational and departmental policies and procedures including information security and confidentiality policies. Protects all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations. Ability to multi-task in a face paced environment while meeting established production and quality goals/metrics. Strong organizational skills, with ability to effectively prioritize work and daily basis and follow up on open items in a timely manner.

QUALIFICATIONS

EDUCATION: High school diploma/GED or equivalent.

EXPERIENCE: Minimum of 3 years of insurance/collection experience in a medical environment preferred.

Licensure/Certification: None

KNOWLEDGE, SKILLS AND ABILITIES

• Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.)
• Skill in defining problems, diagnostics of common coding errors, and impact on claims processing, collection of data, interpreting billing information.
• Must possess strong interpersonal skills; must be able to communicate effectively with co-workers, the Business Office Manager and must be able to work effectively as a team member within the Business Office.
• Ability to multi-task in a face paced environment while meeting established production and quality goals/metrics.
• Strong organizational skills, with ability to effectively prioritize work and daily basis and follow up on open items in a timely manner.

TYPICAL WORKING CONDITIONS

• Working in professional office environment.
• Involves interaction with management and business office staff.
• May require sitting for long periods.
• It is necessary to view and type on computer screens for long periods and to work in a high volume environment.
• Occasional evening or weekend work may be required.

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch