Medical Claims Team Lead

Duties & Responsibilities

> Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
> Update patient demographics/insurance information in appropriate systems
> Research/ Status unpaid or denied claims
> Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
> Research EOBs for payments or adjustments to resolve claim
> Contacts payers via phone or written correspondence to secure payment of claims Access client systems for payment, patient, claim and data info
> Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
> Secure needed medical documentation required or requested by third party insurance carriers.
> Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
> Perform other related duties as required
> Utilize provider billing manuals to obtain billing guidelines and requirements.
> Write appeal letters for technical appeals
> Verifies accuracy of underpayments utilizing contracts and claims data.
> Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
> Utilizes reports for analysis and to monitor follow up activities and prioritization
> Assists organization with working through special projects as needed
> SME for colleagues and provide direction for resolution of accounts
> Assists in new hire training
> Assists in content building of training materials

Qualifications & Competencies

> 3+ years of medical collections/billing experience
> 2+ years of experience as a Team Leader
> Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
> Expert knowledge of third-party billing guidelines
> Expert knowledge of billing claim forms (UB04/1500)
> Expert knowledge of payor contracts
> Working Knowledge of Microsoft Word and Excel
> Intermediate working knowledge of health information systems (i.e., EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
> Must be willing to work onsite.