Job Summary:
The Team Lead, Claims Encounter is responsible for day-to-day activities surrounding the knowledge and insight for Encounter Submissions and critical issues impacting Encounter Submissions.
Essential Functions:
- Guide and direct successful completion of daily tasks; responsible for onboarding and training of staff
- Responsible for coaching and development of staff including completion of consistent and effective performance feedback/reviews and disciplinary actions
- Prioritize all work, requests and activities; escalate any area of significant issues or risk with recommendation for resolution
- Understand the financial and clinical impact of changes and decisions to the business process to ensure that the Service Level Agreements (SLAs) are achieved
- Recommend changes or modify solutions as necessary to implement enhancements, resolve issues, or improve operational efficiency
- Track issues and status to ensure proper follow-up, coordination with business area and provide solutions
- Update management on projects/initiatives the Claims Encounter team is involved with and coordinate any needed changes with manager
- Monitor and communicate Corporate & Market management with Encounter oversight metrics and reports as required
- Identify and communicate root cause of issues and appropriate proactive resolution to reduce Encounter issues preventing submissions in the future
- Ensure controls, communication and approvals are followed prior to system implementation
- Provide support of vendors, managing SLA’s, regulatory/compliance requirements and contractual metrics conducted by the team. Ensure timely responses and resolution.
- Assist in auditing system and process to ensure accuracy and internal controls are in place to minimize any business issues, financial penalties and sanctions from State and Federal agencies
- Perform any other job duties as requested
Education and Experience:
- Associates Degree or equivalent years of relevant work experience is required
- Minimum of three (3) years of health plan business or systems solutions experience is required
- Exposure to Facets or equivalent system is preferred
- Experience with claims processing skills is preferred
- Prior supervisory experience is preferred
Competencies, Knowledge and Skills:
- Advanced proficiency in Microsoft Suite to include Word, Excel and Access
- Edifecs and Encounters knowledge is preferred
- Data trending and data analysis skills
- High level of programming and systems development knowledge
- Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
- Demonstrated ability to successfully define a portfolio of initiatives including business requirements gathering, definition/prioritization, project scope definition, project staffing requirements, application configuration, testing approach, training, documentation, reporting strategy, and change management process
- Knowledge of regulatory reporting and compliance requirements
- Excellent listening and critical thinking skills
- Effective problem solving skills with attention to detail
- Excellent written and verbal communication skills
- Proven delegation and negotiation skills
- Ability to work independently and within a team environment
- Strong interpersonal skills and high level of professionalism
- Ability to develop, prioritize and accomplish goals
- Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
- Effective conflict resolution skills
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$79,800.00 - $127,600.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.