Claims Specialist Team Lead

BrightSpring Health Services•Louisville, KY

1d•Remote

About The Position

The 3rd Party Claims Specialist Team Lead is a subject matter expert (SME) on the company’s denial research methods, internal and external databases, reporting tools and policies and procedures. The Team Lead is a SME on all types of denials and functions performed by both the Claims Specialist I and Claims Specialist II and acts as a trainer and mentor to both.

Requirements

High School graduate, GED or equivalent experience.
3+ years insurance billing experience.
Specialized understanding of billing requirements in one of the following areas: Medicare Part D, Medicaid, and Commercial billing.
Understanding of revenue cycle functions within pharmacy practice or equivalent setting.
Strong analytical skills, excellent time management and attention to details.
Working knowledge in MS Office Products (Excel, Word) and basic computer knowledge.
Comfortable making phone calls and interacting with internal/external entities.
AS400, Frameworks or QS1, Computer Systems Experience.
Communication, problem solving, detail oriented and teamwork, customer service, and accuracy.
Strong organization skills, self-starter, and confidence.
Must be a positive mentor to all staff.

Nice To Haves

Associates degree, 4 year college or technical degree.
Pharmacy Technician.

Responsibilities

Trains new employees and ensures all applicable training materials are provided and reviewed
Provides support to staff and acts as a mentor/coach to promote a positive environment
Provides feedback on all levels of staff to supervisor to be used in employees one on ones, check-ups and reviews
Identifies staff performance issues and discuss with Supervisor
Provides the necessary re-training or one on one support with staff to assist in meeting the performance expectations
Assists management with fair distribution of work/site assignments being sure to communicate when the workloads are off balance and make suggestions on how to reconcile
Reviews variances and write-offs submitted by staff for accuracy of information and approval requirements before giving to Supervisor for approval
Performs monthly quality assessments on staff to ensure accuracy. Report any identified training needs to Supervisor and Manager for further review and follow-up action plan as needed
Prepares and maintain reports and records for processing as well as run and produce miscellaneous reports as assigned or necessary
Identifies potential financial exposure and risk to the company with underperforming or non-compliant payers
Stays up to date on third-party billing requirements
Monitors and provide support to those assigned to work convert billing exception reports to ensure claims are billed to accurate financial plans timely
Completes billing transactions for non standard order entry situations as required
Provides education to management and team members on payer specific claim processing rules, reimbursement, and other policy guidelines as gleaned by, and confirmed through working directly with payers
Takes initiative to find opportunities and make suggestions for process improvement within the department