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Company

CareSource · 5 hours ago

Team Lead, Claims Encounter (remote) - R8257

United States

Full-time

Remote

Senior Level

$80K/yr - $128K/yr

3+ years exp

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Health CareMedical

Comp. & Benefits

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Responsibilities

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

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Health plan business experienceMicrosoft Suite proficiencyFacets system knowledgeClaims processing skillsData analysis skillsProgramming knowledgeRegulatory compliance knowledgeCPT coding knowledgeICD-9 coding knowledgeICD-10 coding knowledgeHCPCS coding knowledgeSupervisory experienceDelegation skillsCritical thinking skillsConflict resolution skills

Required

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

Advanced proficiency in Microsoft Suite to include Word, Excel and Access

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