Job details
Job type full-time
Full job description
Overview: the medical claims billing support lead will work in support of government and commercial clients by managing and resolving claims and coordinating strategies and activities of an operational unit.
*this position is contingent on contract award* responsibilities:
Coordinate workload and performance across a team of claims analysts and processors
Responsible for team quality and volume metrics; audits the work of claims analysts and claims processors
Manage business processes to include developing and implementing process improvements
Act as a liaison to upper management and the client as required
Handle escalated or complex claims issues
Research and provide insight on pertinent industry best practices, legislation and program changes and claims trends
Responsible for cost, schedule and performance of an operational unit
Manage all staff within the operational unit to include: recruitment, placement, development, performance, compliance, succession planning, terminations and backfills
Plan and implement improvements to increase efficiencies and quality
Collaborate in the development and implementation of policies, procedures and operating goals
Serves as a primary contact for the claims operations for other wtchp functional areas such as member and provider services, call center, medical management, and finance
Prepares reports for program management team
Other duties as assigned
Qualifications:
Requires at least six (6) years of relevant experience
Bachelor’s degree or equivalent preferred
Experience resolving pended healthcare claims, prior approval requests and complex or high dollar claims required
Experience working as a team lead or manager required
Familiarity with medical coding required
Well-versed in microsoft office products
