Medical Insurance Collections Team Lead

Description

• Staff training, feedback, and education on payer trends, policies, procedures, and system functionality
• Develop relationships with third party payers/representatives essential to the claims resolution process
• Creation, distribution, and monitoring of reports distributed to staff
• Perform monthly Quality Assurance reviews and meet with each staff member to review results
• Investigate and examine source of rejects and denials utilizing knowledge of ICD-10 coding, CPT coding and EDI billing
• Read and interpret expected reimbursement information from EOB's and learns legal parameters for State and Federal Laws pertaining to the plan benefits
• Coordinate development and ongoing review/revision of Standard Operating Procedure (SOP) affecting RCM
• Meet with office management to communicate focus areas to reduce AR days
• Daily review and approval of write offs
• Basic supervision of staff
• Answer escalated level inquiries from practices and collectors
• Review all high dollar refund requests prior to submission to accounting
• Monitor payer websites and provide pertinent payer updates to staff, managers, and other departments as needed
• Consistent monitoring of payer portals to ensure requested information is submitted timely
• Assist with Medicare and other payer audit requests

• Submission of escalated appeals
• Follow up on high complexity accounts
• Staff training, feedback, and education on payer trends, policies, procedures, and system functionality
• New hire training
• Develop relationships with third party payers/representatives essential to the claims resolution process
• Creation, distribution, and monitoring of reports distributed to staff
• Perform monthly Quality Assurance reviews and meet with each staff member to review results
• Investigate and examine source of rejects and denials utilizing knowledge of ICD-10 coding, CPT coding and EDI billing
• Read and interpret expected reimbursement information from EOB's and learns legal parameters for State and Federal Laws pertaining to the plan benefits
• Coordinate development and ongoing review/revision of Standard Operating Procedure (SOP) affecting RCM
• Meet with office management to communicate focus areas to reduce AR days
• Daily review and approval of write offs
• Basic supervision of staff
• Answer escalated level inquiries from practices and collectors
• Review all high dollar refund requests prior to submission to accounting
• Monitor payer websites and provide pertinent payer updates to staff, managers, and other departments as needed
• Consistent monitoring of payer portals to ensure requested information is submitted timely
• Assist with Medicare and other payer audit requests
• Follows HIPAA guidelines in handling patient information.

• High School Diploma or equivalent required.
• Computer skills that include a combination of experience in a Windows Operating System, e‑mail, and data entry experience.
• Prior experience with medical billing software is preferred but not required.
• Three to five years in insurance billing required.
• Excellent judgment, dependability, and conscientiousness.
• Demonstrated high ethical standards and integrity.
• Demonstrated attention to detail.
• Demonstrated accuracy and thoroughness; monitors own work to ensure quality.
• Customer and patient service orientation: prompt response to patient needs and ability to manage difficult or emotional customer situations with tact, empathy and diplomacy.
• Ability to work cooperatively in group situations; offers assistance and support to coworkers, actively resolves conflicts, inspires trust of others, and treats patients and coworkers with respect.
• Patient centered care focused, and a team player.
• Handles multiple tasks effectively and efficiently and exhibits commitment to effective problem‑solving techniques when issues arise.
• Continuously acts to maintain a safe, clean, healthy, and fun work environment consistent with AVP’s Mission and Vison.
• Arrives on time, ready to work, and demonstrates minimal absenteeism.
• Demonstrates effective problem‑solving skills
• Knowledgeable of Medicare and Medicaid billing and reimbursement concepts and principles.
• Willingness to submit to a background check

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