- Manages 55+ team members and functions that may include, but are not limited to, payments, refunds denial analysis, open accounts receivable and customer service for respective clients and billing platforms
- Compile and analyze information identified through A/R reports through A/R Pivots, MPF, Business Objects or specified billing platforms for current and/or potential billing issues specific to outstanding receivable and denial management
- Develop necessary summaries or reports using Microsoft-Excel/Word
- Presents data to appropriate parties and partners to develop resolutions with domestic and offshore affiliates as necessary
- Independently works to ensure that daily team operations flow smoothly; to include, but not limited to daily production assignments that will continue to develop understanding and knowledge of processing guidelines and expectations of respective client(s) payer mix
- Works in collaboration with peers, Manager(s) and Director(s) for guidance and reorganization of workflow to ensure internal and external business needs are met
- Participate in meetings with Payers, internal departments, Client contact(s) and TES Management, etc. to address trends in denials or unprocessed claims
- Creates and distributes department wide communications or pathways, notifying staff of updated insurance guidelines/processing information; to include, but not limited to pathways and social text updates
- Holds regular staff meetings to communicate changes in process, business results, organizational changes or environmental changes
- - Identifies and facilitates individual and/or team training needs for new or established team members
- Handles escalated client/patient issues that include but are not limited to unhappy patients/callers and client contacts that may require additional system or technical knowledge
- Ensures the effectiveness of the talent management process for the team by anticipating staffing needs, effective interviewing and on-boarding of new staff. Conducts timely and effective mid-year and annual performance reviews, and creates staff development plans to promote competency/skill development.
- Engages in employee performance management; to include, but not limited to creation, maintenance and delivery of performance documents and appraisals for direct reports, routine review of productivity utilizing applicable reports and systems available
- Completes and delivers quality reviews for staff development and process improvement; to include, but not limited to monthly 1:1 feedback sessions, recognition for strong performance, performance management for underperformers
- Reviews quality assurance reports with team leaders and employees; providing feedback on areas of success and improvement for domestic and offshore staff
5+years of medical claims experience along with strong management experience. Experience with patient information/claims system processes.
- Strong ability to adapt to change; takes responsibility for own actions and positioned as an individual that is able to be counted on to ensure the accomplishment of projects/assignments based on commitments made.
- Strong business auditing skills and attention to detail, with the ability to identify, evaluate and report on financial transactions and internal controls. Assess and report on the efficiency and effectiveness of business process and operations.
- Ability to provide a high level of customer service to internal and external customers
- Effective decision making skills that allow for logical, sound judgment in the use of resources; assessing and determining an appropriate course of action based on factors available, including set procedures and guidelines; selecting solutions and alternatives in a timely manner.
- Ability to work independently and drive execution by understanding actions and performance necessary to motivate staff and provide an environment that strives for continuous improvement.
- Strong leadership skills with the ability to clearly communicate verbal or written expectations; outlines goals and objectives for all levels of staff within the team to achieve success.
- Capacity to evaluate interviewed candidates and make decisions that will match the most qualified individual to a position based on job function and requirements; strong talent champion that minimizes turnover.
- Represents the office/Organization in a positive manner; supports and encourages strong morale and spirit in his/her team.
- Fosters a positive team work environment, to include, respectful, open communication and management practices while exercising confidentiality of sensitive subject matter at all times.
- Can marshal resources to complete tasks and orchestrate multiple activities at once to accomplish goals
- Can negotiate skillfully in tough situations; can win consensus without damaging relationships
- Works well with others; ability to work with and communicate with individuals of varying disciplines
Additional Knowledge & Skills
- Responsible for identifying individual and team training needs, application and assessing effectiveness of training
- Responds to staff question and concerns in a timely, professional manner
- Manages payroll approval and time off for respective staff based on guidelines and exceptions
- Completes, maintains and processes paperwork necessary for staff and client records
Undergraduate degree in related field or equivalent.