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. #J-18808-Ljbffr