Claims Service Rep Lead

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!
 

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.
 

Responsible for resolving more complex outstanding unpaid and/or unprocessed medical claims and denied claims submitted to third party payers on behalf of providers. Works closely with CBO staff to capture denial data in the interest of denial prevention and provider education. Resolves outstanding claims by accessing third party payer web sites, making and accepting phone calls, and sending and receiving correspondence to and from third party payers and various government agencies. Works under minimal supervision and may adapt procedures, processes, and techniques to meet the more complex requirements of the job. Serves as lead by answering questions, conducting training, preparing educational materials, mentoring for Claims Services Reps. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

 

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview
Responsible for resolving more complex outstanding unpaid and/or unprocessed medical claims and denied claims submitted to third party payers on behalf of providers. Works closely with CBO staff to capture denial data in the interest of denial prevention and provider education. Resolves outstanding claims by accessing third party payer web sites, making and accepting phone calls, and sending and receiving correspondence to and from third party payers and various government agencies. Works under minimal supervision and may adapt procedures, processes, and techniques to meet the more complex requirements of the job. Serves as lead by answering questions, conducting training, preparing educational materials, mentoring for Claims Services Reps. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Serves in the lead capacity for Claims Service Reps for the Central Business Office. Provides guidance to Claims Service Reps to include answering questions, solving problems and researching issues. Assists in scheduling activities to ensure adequate departmental staffing. Ensures staffing as appropriate to meet customer needs and within budgetary and productivity requirements.
• Regularly reviews the work of Claims Service Reps to ensure quality of work and performs audits as needed. Documents and addresses Associate performance and competencies and submits documentation to manager.
• Participates in interviewing potential new Associates, has input into Associate evaluations and corrective actions.
• Develops, maintains, and conducts a comprehensive training program for Claims Service Reps in areas such as policies, procedures, workflow and computer system operation. Organizes and conducts continuing in-service training classes for current Associates.
• Researches and reviews all payor recoupment requests.
• Performs special projects for department.
• Reviews more complex accounts, files appropriate claims, and provides follow-up on claims. Evaluates account status and performs follow-up to insure account resolution.
• Contacts patients and insurance companies to identify barriers in getting more complex claims paid.
• Routes more complex accounts back to appropriate parties after self-pay balances are determined.
• Provides research on more complex bill disputes, handles adjustments and follows up on outstanding claims.
• Performs other job functions as assigned or requested.

Education/Formal Training Requirements

• High School Diploma or Equivalent

Work Experience Requirements

• 1-3 years Billing
• 1-3 years Customer service

Knowledge, Skills and Abilities

• Strong organizational and time management skills.
• Strong telephone, communication and diplomacy skills.
• Personal computer skills for the purpose of accessing information on the internet and other applications to obtain information.
• Ability to work without close supervision and to exercise independent judgment.
• Ability to organize multiple tasks and workflow for self and others as it relates to training, preparing educational materials, and providing guidance.

Supervision Provided by this Position

• Leads the Claims Service Rep incumbents by providing guidance, training, fe