Team Lead, Peer-to-Peer and Appeals

TurningPoint Healthcare•Lake Mary, FL

About The Position

As a subject matter expert, the Peer-To-Peer/Appeal Team Lead will provide effective guidance and support over the daily operations of the assigned team to ensure the organizational needs and client/ customer expectations are met.

Requirements

Minimum of 2 years’ experience in Customer Service, or any healthcare operations, is required.
Excellent verbal and written communication skills.
Must possess strong organizational skills; ability to multitask; commitment to customer service; ability to problem solve.
Must be able to foster a positive and productive work environment.
Phone Queue Experience and Data Entry Skills

Nice To Haves

Experience as a Peer-to-Peer Coordinator or Appeal agent highly preferred
Associates Degree in a business or health related field is preferred.
Deescalation, defusal, and time management skills
Creating a Safe, Effective Environment, Verbal Communication, Listening, Confidentiality, Dependability, Emotional Control, Teamwork.
Strong organizational skills; commitment to customer service; ability to problem solve; strong presentation skills throughout all levels of the organization. Must be able to foster a positive and productive work environment with ability to lead, build teams and motivate staff.
Proficient in Microsoft Word, Excel, and Outlook.

Responsibilities

Ensure high priority in delivering service excellence both independently and across the team.
Answer client/customer inquiries and develop action plans for any identified areas of improvement.
Foster timely and accurate communication and distribution of company policies, procedures and responsibilities that directly relates to the assigned contract/ client expectations.
Provide satisfactory resolutions to customer issues escalated from the Clinical Operations Representatives.
Monitor and maintain the key performance indicators as outlined by management.
Monitor, evaluate and report on any client trends that may impact staffing schedules to include business demands and case volumes.
Assist with the hiring, development, and evaluation of all staff, including handling corrective action when necessary.
Support Clinical Operations daily with working the phone queue and creating cases, especially during peak/ overflow periods.
Assist with coaching / training the Clinical Operations Representatives to ensure that they achieve or exceed company expectations for quality of services rendered by providing regular, constructive feedback and guidance to develop team members to their full potential.
Support organizational and departmental QA/ QI initiatives to include auditing as appropriate.
Serve and protect the company by adhering to URAC standards, professional standards, policies and procedures, federal, state, and local requirements, and professional and licensing standards.
Participate in educational opportunities, read professional publications, maintain personal networks; participate in professional organizations.
Enhance company reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Follow company policies and procedures and conducts annual performance reviews in a timely manner.
Respects and maintains HIPAA confidentiality guidelines.
Other duties as directed. This includes, but is not limited to: Daily Chat Checks, Maintaining TAT, Skill Building Hosting, Audits