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Team Lead – Claims and Payment Posting

*ETHOS LABORATORIES* – Newport, KY

LOCATION: This position is located in Newport, KY, two blocks from Newport on the Levee.

HOURS: Monday – Friday, 7:30AM – 3:30PM

POSITION SUMMARY:

The Claims and Payment Posting Team Lead is responsible for the day to day operations and workflow within the Payment Posting and Claims area of the Billing Department. This position oversees the following processes: Zero Pay, Manual, and Electronic Payment Posting, and claims submission, including workers compensation and rejections. This positions reports month-end reconciliation, processes patient refunds, troubleshoots payment posting and claims workflow, ensures productivity standards are met, and communicates with Billing Manager. This position requires attention to detail, exception interpersonal skills, developed technical skills and strong leadership abilities.

EDUCATION AND EXPERIENCE REQUIREMENTS:

  • High School Diploma or GED
  • 2 years of claims submission/rejection experience in medical billing setting
  • 2 years of payment posting experience in medical billing setting
  • 2 years of experience associated with progressive responsibility, overseeing people and processes in a medical billing setting

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Monitors and communicates positive and negative trends and issues that may affect lab billing and reimbursement as seen during rejection process
  • Responsible in documenting and performing staff’s monthly audits
  • Ensures staff’s productivity standards are met
  • Ensures all payments are posted within the expected guideline
  • Ensures all rejections are worked within the expected guideline
  • Acts as liaison between billing department and technology vendors (Emdeon/ADS/LIS)
  • Reports monthly reconciliation to Billing Manager, Controller and CFO by 7th business day of the following month
  • Tracks and maintains data and performance indicators on a daily, weekly, monthly, quarterly and annual basis
  • Reviews and processes patient refunds
  • Effectively delegates tasks to maximize strength of employees
  • Communicates any changes or adjustments to workflow
  • Encourages positive communication and interactions within the department and inter-departmentally to increase collaboration and teamwork
  • Performs the duties of Payment Posters and Claims Specialists as needed
  • Assists in reviewing and creating SOPs and forms when needed for Payment Posting and Claims
  • Assists in effectively troubleshooting issues as they arise in regards to claim submission, rejections and payment posting
  • Ensure completion of daily tasks and delegate additional tasks essential to the process
  • Participates in department meetings
  • Assists in maintaining interdepartmental communication and cooperation
  • Performs on-boarding, training and orientation activities with new employees
  • Provides day to day support and training to staff to ensure efficient operations
  • Ensures completion of training checklists for Payment Posters and Claim Specialists
  • Performs competency assessments, twice within first year, then annually thereafter for staff assigned
  • Identifies possible training deficiencies
  • Documents incidents and accidents on the appropriate forms and ensures Billing Manager is aware of these in a timely manner, depending on the seriousness of issue
  • Assists in ensuring adherence to company policies, including attendance, dress code, and lab safety
  • Ensures adherence to all regulatory requirements
  • Communicates issues, as needed, with Billing Manager, in a timely manner, and provides verbal summary of payment posting activities, issues, resolutions, etc. at production meetings

CORE COMPETENCIES AND QUALIFICATIONS:

  • Must be able to motivate, coach and mentor employees for the highest level of performance
  • Must be able to prioritize and perform multiple tasks in a dynamic environment
  • Ability to model time management, conscientiousness, dedication, self-discipline, accountability, and responsibility
  • Ability to work independently and cohesively as part of a team
  • Ability to foster an environment of employee development and collaboration within and between departments
  • Must be able to delegate and accomplish goals through others
  • Requires a high level of attention to detail, critical thinking and problem solving
  • Ability to exercise independent judgement
  • Utilizes leadership principles to anticipate and influence change
  • Prompt and regular attendance
  • Effective verbal and written communication
  • Excellent phone etiquette
  • Knowledge of all aspects of the Revenue Cycle
  • Ability and experience with Microsoft Outlook, Word, and Excel
  • Follow all department and company policies and procedures