Medical Insurance Collections Team Lead

Atlantic Vision Partners•Richmond, VA

15d

About The Position

What You’ll Do Submission of escalated appeals Follow up on high complexity accounts Staff training, feedback, and education on payer trends, policies, procedures, and system functionality New hire training Develop relationships with third party payers/representatives essential to the claims resolution process Creation, distribution, and monitoring of reports distributed to staff Perform monthly Quality Assurance reviews and meet with each staff member to review results Investigate and examine source of rejects and denials utilizing knowledge of ICD-10 coding, CPT coding and EDI billing Read and interpret expected reimbursement information from EOB's and learns legal parameters for State and Federal Laws pertaining to the plan benefits Coordinate development and ongoing review/revision of Standard Operating Procedure (SOP) affecting RCM Meet with office management to communicate focus areas to reduce AR days Daily review and approval of write offs Basic supervision of staff Answer escalated level inquiries from practices and collectors Review all high dollar refund requests prior to submission to accounting Monitor payer websites and provide pertinent payer updates to staff, managers, and other departments as needed Consistent monitoring of payer portals to ensure requested information is submitted timely Assist with Medicare and other payer audit requests Follows HIPAA guidelines in handling patient information.

Requirements

High School Diploma or equivalent required.
Computer skills that include a combination of experience in a Windows Operating System, e-mail, and data entry experience.
Three to five years in insurance billing required.
Excellent judgment, dependability, and conscientiousness.
Demonstrated high ethical standards and integrity.
Demonstrated attention to detail.
Demonstrated accuracy and thoroughness; monitors own work to ensure quality.
Customer and patient service orientation: prompt response to patient needs and ability to manage difficult or emotional customer situations with tact, empathy and diplomacy.
Ability to work cooperatively in group situations; offers assistance and support to coworkers, actively resolves conflicts, inspires trust of others, and treats patients and coworkers with respect.
Patient centered care focused, and a team player.
Handles multiple tasks effectively and efficiently and exhibits commitment to effective problem-solving techniques when issues arise.
Continuously acts to maintain a safe, clean, healthy, and fun work environment consistent with AVP’s Mission and Vison.
Arrives on time, ready to work, and demonstrates minimal absenteeism.
Demonstrates effective problem-solving skills
Knowledgeable of Medicare and Medicaid billing and reimbursement concepts and principles.
Willingness to submit to a background check

Nice To Haves

Prior experience with medical billing software is preferred but not required.

Responsibilities

Submission of escalated appeals
Follow up on high complexity accounts
Staff training, feedback, and education on payer trends, policies, procedures, and system functionality
New hire training
Develop relationships with third party payers/representatives essential to the claims resolution process
Creation, distribution, and monitoring of reports distributed to staff
Perform monthly Quality Assurance reviews and meet with each staff member to review results
Investigate and examine source of rejects and denials utilizing knowledge of ICD-10 coding, CPT coding and EDI billing
Read and interpret expected reimbursement information from EOB's and learns legal parameters for State and Federal Laws pertaining to the plan benefits
Coordinate development and ongoing review/revision of Standard Operating Procedure (SOP) affecting RCM
Meet with office management to communicate focus areas to reduce AR days
Daily review and approval of write offs
Basic supervision of staff
Answer escalated level inquiries from practices and collectors
Review all high dollar refund requests prior to submission to accounting
Monitor payer websites and provide pertinent payer updates to staff, managers, and other departments as needed
Consistent monitoring of payer portals to ensure requested information is submitted timely
Assist with Medicare and other payer audit requests
Follows HIPAA guidelines in handling patient information.