Team Lead-Claims (Hybrid, Morrisville, North Carolina Based)

The Claims Team Lead provides training/development, consultation, and direction to Claims Research Analysts and collaborates with Claims leadership and other departments to improve claims processes and Claims system changes.   The Claims  Team Lead also facilitates peer reviews and independent claims audits to identify areas for improvement and correction.  The position provides guidance and training/technical assistance to network providers in an effort to strengthen the performance of Alliance Behavioral Healthcare’s provider partners. This position creates reporting tools to aid in identification of areas needing attention and to communicate performance.  

This position will allow the successful candidate the ability to work remote certain days of the week. The employee will be required to come into the Home office (Morrisville, NC) on certain days as approved by their supervisor.

Responsibilities & Duties

Provide Guidance and Consultation to Claims Research Analysts

•  Assist the Claims Research Analysts in reviewing claim errors
• Provide daily consultation to Claims Research Analysts to resolve processing issues
• Facilitate monthly peer reviews
• Ensure staff is taking the appropriate steps even when it may require escalation for resolution
• Role model professional communication and conduct at all times

Provide Training and Development  to Claims Research Analysts

• Onboard and train new claims staff
  
• Provide ongoing in-person and virtual learning opportunities to include 1:1 training, shadowing, provision of routine feedback
  
• Provide claims processing training for new and existing staff

Provide Training/Technical Assistance/Resolutions to Providers 

• Facilitate in-person and virtual claims processing training for providers
  
• Provide technical assistance on claims processing issues to providers
  
• Research provider concerns or complaints and resolve.   Escalate complaints to grievance team when appropriate

Analyze Data and make recommendations

• Review and analyze daily, weekly and monthly reports to help track processes and recommend procedure and process changes to increase productivity 
  
• Review claims production and quality levels for performance and monitor Provider/Member feedback.  Refer areas of staff performance concerns to supervisors
  
• Monitor and record performance measures and compile performance reports 

Improve Quality of Claims Processing procedures and performance

• Develop and implement approved new and updated procedures and desk references to improve quality and performance
  
• Stay abreast of related regulatory, compliance and departmental updates to meet departmental metric requirements
  
• Collaborate with Contracts, Credentialing, Enrollment, Provider Network teams to assist providers with successful claims submissions
  
• Maintain a working knowledge of Provider Network functions to appropriately advise/guide providers with claims-related issues
  
• Collaborate with Utilization Management to resolve and manage system changes to allow for successful claims adjudication
  
• Provide backup coverage to supervisory staff as needed

Support Expansion and New Business

• Learn new skills related to expansion and new business requirements per Alliance Health contracts. This includes: coverage of additional catchment areas, new covered services, processing and handling of physical health claims

Education & Experience

Required:

High school diploma or equivalent and four (4) or more years of experience processing behavioral and physical health claims and analyzing claims processing data

Preferred:

Experience leading a team and conducting trainings and presentations

Knowledge, Skills, & Abilities

• Claims Processing- Behavioral, Physical
• Training/Presentation
• Microsoft Office Package
• Communication- Verbal
• Organization
• Complex Problem Solving
• Time Management;