Team Lead, Quality & Performance

Job Type Full-time Description

Job Purpose

The Team Lead, Quality & Performance supports quality auditing, analysis, reporting and the development of plans that lead to positive outcomes. The position also requires engagement in working on risk identification, diagnosing issues, identifying process improvement solutions and process improvement implementation methods utilizing sound principles. Continuous engagement and collaboration with leadership is essential.

Duties and Responsibilities

• Conduct routine quality audits based on both random and targeted sampling of data.
• Monitor productivity data for employees who are subject to the QA review process and prepare management communication reports.
• Maintain in-depth knowledge of department policies and standard operating procedures (SOPs)
• Assess quality of the Insurance Follow-up and other Accounts Receivable functions and Claim Edits teams by reviewing and auditing accounts for timely and proper follow-up.
• Audits defined company and/or workflow account defects.
• Records results of all QA accounts assessments and audits in the audit tool
• Identify inefficiencies and process gaps that are contributing to decreases in performance and recommend best practices for ongoing process improvement.
• Participates in quality calibration initiatives with management, training, and operations team, resolves routine questions or problems, escalating complex issues to management as needed.
• Utilizes audit findings to report on trends and recommend training modifications to management.
• Meet with individual team members to conduct monthly quality assurance scoring and feedback sessions.
• Prepare and distributes quality assurance performance statistics.
• Frequent calibration of quality assurance monitoring to ensure consistent administration of quality assurance objectives.
• Adheres to the policies and procedures established for the client/team. 
• Ability to identify and correct medical billing errors.
• Understanding of under payments and credit balance process
• Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.
• Act cooperatively and courteously, co-workers, management, and internal clients
• Work independently from assigned work queues.
• Other duties as assigned by the management team. 
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Requirements

Qualifications

• Associate degree or equivalent 2+ years previous work experience in healthcare insurance collections, self-pay collections and customer service in a call center setting or compliance and/or training
• Must have strong understanding of the basic healthcare revenue cycle operational processes such as the functions of insurance, patient billing & collections, Managed Care, Medicare, Medicaid, and Commercial Practices
• Knowledge of EOBs, CPT & ICD-9 & 10 codes, HCFAs, UB92s, HCPCS, DRGs and authorizations/referrals. Coding certification preferred and minimum of 6 months hands on coding experience preferred
• Experience with practice management systems. EPIC PB, Allscripts and/or Cerner preferred
• Experience with Physician/Professional Billing
• Knowledge of the denied claims and appeals process
• Ability to navigate through multiple software and computer applications
• Detail oriented and well organized
• Ability to perform under pressure in a calm manner & maintain a positive attitude
• Excellent, customer service, verbal, written, listening and interpersonal skills
• Capacity to maintain a high level of objectivity when completing staff reviews
• Proficient computer skills including Microsoft Office Suite. Must have intermediate Excel skillset
• Self-motivated and resourceful with the ability to multitask and successfully operate in a fast paced, team environment
• Experience with training new users
• Ability to work well individually and in a team environment
• Must adapt well to change and successfully set and adjust priorities as needed
• Strong analytical skills

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work