Healthcare Operations Support Specialist Lead (SCA)

Performant Corp • San Angelo, TX

2d • $22 - $29 • Remote

About The Position

The HCS Operations Support Services team performs activities to healthcare audit client inventory activities such as claim re-pricing, client inventory status reporting, responding to client inquiries, researches and resolves issues that may arise, and other client account ad-hoc reporting and inventory support activities. This Lead position serves as the team’s first point of escalation for Operations Support Representatives and Analysts, performs coordination and follow-up on regular operational inventory activities within Operations Support as well as broader audit team, supports assigning team resources for ad-hoc reports and requests, supports team training for new team members, performs team quality assurance reviews, and other duties in support of the team and management to provide excellent services to our healthcare clients.

Requirements

• Well-rounded knowledge and skills specific to the medical claim billing, medical terminology, medical coding, re-pricing claims, along with some experience in basic medical data analytics
• Experience in some capacity of medical claim quality assurance, or past demonstrated experience in a QA function.
• Strong working proficiency with Microsoft Office suite. Must have strong Excel skills and demonstrated ability to effectively leverage a multitude of templates, formats, and data spreadsheet tools.
• Strong technical skills – comfort working with databases and tools to extract and analyze data.
• Previous experience with various database tools such as DPE and others to organize information and reporting into value added work product.
• Ability to communicate professionally both verbally and in written form with internal and external audiences.
• Good critical thinking, questioning, and listening skills.
• Time management skills to effectively manage diverse workload while completing work within allocated time frames in a fast-paced dynamic environment.
• Must have excellent organization skills and attention to detail.
• Ability to work independently, and work cooperatively within the team, providing strong understanding of workflows, claim escalations, reporting tools, and team training.
• Demonstrated ability to lead by example for operations staff demonstrating integrity, reliability, strong initiative and work ethic, work attendance, problem solving, and organization of work.
• Can meet objectives with minimal supervision.
• High school degree or GED required.
• Minimum 3 years of experience involving medical billing/claims required.
• Other requirements may apply.

Nice To Haves

• Some college, AS or BS degree is plus.
• Six (6) or more years preferred.

Responsibilities

• Serves as first point of escalation for questions and issues on the team. Use good judgment to inform and/or escalate to management as may be appropriate. Leverage knowledge and acumen in the medical billing and claims industry to provide actions-based solutions for clients, and answer staff questions.
• Assists in the gathering of information, data points, and current reporting tools to resolve any conflicts or concerns of claim discrepancies.
• Responsible for ensuring that regular data reporting from the team for internal business groups and for clients are delivered in accordance with schedule and scope.
• Coordinates and follows-up with audit groups to monitoring data flow coming from selection team. Inform appropriate management and audit team members as appropriate for delays or issues.
• Reviews incoming requests for Ad Hoc reports, from varying resources, and assessing the skills and capabilities of the team, assigns the creation of the report to the employees.
• Creates and delivers scheduled and ad-hoc reporting on-time and with high quality.
• Contributes to special ad hoc report creation and analysis to create effective resolutions for client requests, inventory monitoring and management, medical records request letters, and other time sensitive work product.
• Monitors claim and case inventory reports and utilizes industry knowledge and company procedures to effectively assign case inventories to meet daily, weekly, and monthly work product objectives.
• Requests insights drawn from DPE spreadsheet queries, working with excel filter tools, and knowledge of DPE reporting to extract and assign needed.
• Provides some basic analytic review in event of client escalates concerns on re-pricing initiatives or determinations, and the client seeks solutions from data reporting.
• Participates in weekly and monthly communication and service focused meetings both internally with staff and as a knowledge participant for client calls, building working relationships of trust and reliability with client(s).
• Responsible for reporting meeting outcomes, minutes, and accomplishments applicable to the team.
• Responsible for the on-the-job training of staff on work processes and tasks, standard operating procedures, system proficiency, and changes as applicable based upon internal or client requirements.
• Contribute to the development and/or improvement and administration of team productivity and Quality Assurance metrics and procedures.
• Monitor activity volume and staff capacity to ensure resources are aligned with business needs. Provide insights to management as may be needed for staff or workflow planning.
• Review team and individual productivity and quality against established metrics and identify potential issues or gaps, making recommendations to applicable supervisor or management on performance improvement needs.
• Other Duties as assigned.

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.
• For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED