Revenue Recovery Team Lead

Definition and Role

The Denials Team Leader works directly with the Denial Management Specialists to ensure the practice payment posting, denials, appeals, secondary claims, and collections are entered and worked in an accurate, comprehensive, and efficient manner.  Experienced in all aspects of medical billing to both government and commercial insurances.  This role reports directly to the Director of Revenue Cycle.

Qualifications and Skills

• A minimum of a bachelor’s degree in a related field is preferred.  Sufficient work experience in medical billing with an emphasis in denial management may substitute and/or augment a degree.
• Dedication to customer service is a must.
• Great communication skills and be able to communicate in English.
  
• Great work ethic; will go above and beyond to exceed internal customer expectations.
  
• Outstanding interpersonal skills and great team player.
• Must be able to work independently with a high degree of self-initiative.
  
• Excellent problem-solving abilities.
  
• Knowledge of standard MS Office products.
  
• Ability to work well under pressure and adapt to changes in project priorities.
• Must be able to accommodate a flexible work schedule.

Job Responsibilities and Duties

• Responsible for the oversight of staff; positive coaching.
  
• Assists with interviewing and hiring of denial management staff.
  
• Assists with quality and staff productivity monitoring.
  
• Assessment and organization and monitoring of daily routine workloads including handling staff schedule changes ensuring no negative impact to workflow including but not limited to:

• Denial resolution and improving the revenue cycle.
• Interpreting, posting, and balancing Explanation of Benefits and Remittance Advices.
  
• Researching, correcting, and re-submitting rejected and denied claims.
  
• Reviewing delinquent accounts and making payment arrangements with patients.
  
• Preparing appeals for denied claims.
  
• Answering patient’s billing questions.

• Directly answers patient account claim questions when directly working or is escalated.
  
• Acts as knowledge resource for denial management staff as well as other departments/offices within MedCentris as needed.  
  
• Helps to develop and maintain associated policies and procedures, and reports for tracking/trending staff performance and other reports as required.  
  
• Interacts with internal providers and external facilities to procure documentation for denial management as necessary.
  
• Participates in problem resolution; troubleshoots and/or contacts Information Technology support to report problems with hardware or software to expedite problem resolution.  
  
• Maintains current and thorough knowledge and understanding of current coding schemes, regulatory rules, guidelines, and updates as well as a thorough knowledge of current database operations, processes, problems, and changes.
  
• Promotes teamwork in the area and customer relationships through prompt and courteous service.
  
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.
  
• Contributes to team effort by accomplishing individual productivity related results. 
  
• Steps in to cover team members and/or work special projects.
  
• Prepares and enhances training materials and conducts training sessions for coding and charge entry specialists as well as providers.
  

Physical Requirements

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing this job the employee is frequently required to sit, talk, and hear.
• The employee is occasionally required to walk, use hands and fingers to feel, handle, or operate objects, tools, or controls, and reach with hands and arms.
• The employee must occasionally lift and/or move objects weighing up to 25 pounds.
• Specific vision abilities required by this job include close vision and the ability to adjust and focus