Healthcare Operations Support Specialist Lead

Role Overview

• Serves as first point of escalation for questions and issues on the team
• Use good judgment to inform and/or escalate to management as may be appropriate
• Leverage knowledge and acumen in the medical billing and claims industry to provide actions-based solutions for clients, and answer staff questions
• Assists in the gathering of information, data points, and current reporting tools to resolve any conflicts or concerns of claim discrepancies
• Responsible for ensuring that regular data reporting from the team for internal business groups and for clients are delivered in accordance with schedule and scope
• Coordinates and follows-up with audit groups to monitoring data flow coming from selection team
• Inform appropriate management and audit team members as appropriate for delays or issues
• Reviews incoming requests for Ad Hoc reports, from varying resources, and assessing the skills and capabilities of the team, assigns the creation of the report to the employees
• Creates and delivers scheduled and ad-hoc reporting on-time and with high quality
• Contributes to special ad hoc report creation and analysis to create effective resolutions for client requests, inventory monitoring and management, medical records request letters, and other time sensitive work product
• Monitors claim and case inventory reports and utilizes industry knowledge and company procedures to effectively assign case inventories to meet daily, weekly, and monthly work product objectives
• Requests insights drawn from DPE spreadsheet queries, working with excel filter tools, and knowledge of DPE reporting to extract and assign needed
• Provides some basic analytic review in event of client escalates concerns on re-pricing initiatives or determinations, and the client seeks solutions from data reporting
• Participates in weekly and monthly communication and service focused meetings both internally with staff and as a knowledge participant for client calls, building working relationships of trust and reliability with client(s)
• Responsible for reporting meeting outcomes, minutes, and accomplishments applicable to the team
• Responsible for the on-the-job training of staff on work processes and tasks, standard operating procedures, system proficiency, and changes as applicable based upon internal or client requirements
• Contribute to the development and/or improvement and administration of team productivity and Quality Assurance metrics and procedures
• Monitor activity volume and staff capacity to ensure resources are aligned with business needs
• Provide insights to management as may be needed for staff or workflow planning
• Review team and individual productivity and quality against established metrics and identify potential issues or gaps, making recommendations to applicable supervisor or management on performance improvement needs
• Other Duties as assigned

Requirements

• High school degree or GED required
• Some college, AS or BS degree is plus
• Minimum 3 years of experience involving medical billing/claims required
• Six (6) or more years preferred
• Well-rounded knowledge and skills specific to the medical claim billing, medical terminology, medical coding, re-pricing claims
• Experience in some capacity of medical claim quality assurance, or past demonstrated experience in a QA function
• Strong working proficiency with Microsoft Office suite
• Must have strong Excel skills and demonstrated ability to effectively leverage a multitude of templates, formats, and data spreadsheet tools
• Strong technical skills – comfort working with databases and tools to extract and analyze data
• Previous experience with various database tools such as DPE and others to organize information and reporting into value added work product
• Ability to communicate professionally both verbally and in written form with internal and external audiences
• Good critical thinking, questioning, and listening skills.
• Time management skills to effectively manage diverse workload while completing work within allocated time frames in a fast-paced dynamic environment.
• Must have excellent organization skills and attention to detail.
• Ability to work independently, and work cooperatively within the team, providing strong understanding of workflows, claim escalations, reporting tools, and team training.
• Demonstrated ability to lead by example for operations staff demonstrating integrity, reliability, strong initiative and work ethic, work attendance, problem solving, and organization of work.
• Can meet objectives with minimal supervision.

Benefits

• medical
• dental
• vision
• HSA/FSA options
• life insurance coverage
• 401(k) savings plans
• family/parental leave
• paid holidays
• paid time off annually