Healthcare Insurance Team Lead
Job Purpose: Assist the Management Team by giving staff within the Insurance Hub day-to-day direction in performing their essential job functions. Ensure currency and best practices in workflows. Ensure timeliness of account handling/tags/billing/reporting to clients, etc. to achieve maximum revenue for the department. Work in conjunction with Self Pay Unit Managers and Team Leads to knowledge share. Work in conjunction with the Director in process and workflow improvement. Communicate with clients as needed surrounding insurance account handling.
Essential Job Functions:
1. Day to day management of team of Insurance Collectors within the Insurance HUB.
a. Oversees and delegate workflows between Insurance Collectors to achieve maximum efficiency and currency with regard to discovered insurance.
b. Cross train team so all can perform all insurance related functions for all EO clients including verification, billing, data entry and follow-up.
c. Prepare and maintain training workbooks for each EO client outlining payer and client specifics.
d. Point person on second level training of new insurance team members on appropriate systems (DM, EPIC, Soarian, SMS, MediTech, McKesson Star, Connance Agency Manager, etc.).
e. Interview candidates and be part of selection process for Insurance Collector position.
f. Provide first level assistance to staff by answering questions, reviewing insurance procedures, participating in client calls, addressing escalated issues, researching client complaints and or providing feedback.
g. Run weekly performance metrics by team member and by client. Ensure maximum efficiencies are obtained.
h. Conduct weekly meetings with team members and provide updates to the Management Team regarding issues discussed. The goal of this meeting is to provide the staff an open forum to discuss collection related issues that affect clients and tools needed for improvement.
i. Prepare and deliver monthly Development Plans with team members.
2. Craft and facilitate insurance training seminars in conjunction with management to continue to education self pay patient account reps.
3. Review and provide feedback on system or patient account rep gaps to appropriate managers and Director.
4. Subject matter expert for workflow re-designs and development within the department including - DM system enhancements, testing data and workflows in DEV and LIVE environment, tracking and auditing new workflows and GAP analysis of enhancements. Creatively and continuously propose ways to enhance efficiency within DM system.
5. Provide assistance as a resource to aide in driving revenue for the EO Department. Such functions include daily, weekly and monthly audits for missing revenue, preparing missing payment data sources and or delegating to team.
6. Provide resource as necessary during client conference calls to address insurance and or process related questions as specific to workflows:
a. Connance Agency Manager
b. EPIC work queues
c. Envision QCATS
7. Maintain a working inventory of accounts equal to 25% of the volume a normal reps inventory would carry. Manage a queue of problem accounts and make follow-up calls or provide other supervisory resolution action as needed. Escalate problems as deemed appropriate.
8. Other duties as assigned by management.
Expert in insurance claims processing. Proficient knowledge of Revenue Cycle in its entirety. Capable of meeting production quotas. Familiarity with all EO client systems, strong understanding of insurance billing, follow-up, denial management, RAC audits and appeals. Basic knowledge of Coding, ICD10, Medical Terminology, Credentialing, Clearinghouse and Claim Edit Process. Understanding of HIPPA and HITECH.
Experience: At least 2 year's experience in early out or bad debt in such role as a self-pay or insurance collector, hospital or physician billing practice. Working knowledge of medical terminology dealing with insurance related issues. Experience with standard office software products a must. Strong Excel background.
Demonstrated leadership, analytical, communication and problem solving skills and the ability to act/decide accordingly. Ability to collect, create and research complex or diverse information. Exceptional customer service and the ability to plan organize and exercise sound judgment. Client facing professionalism in all facets of communication. Team player with a professional, positive attitude that embraces the Parallon Values of: Integrity, Unity, Service, Learning, Accountability and Respect.
Disclaimer: The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhaustive list of responsibilities, duties and skills required.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom