Recovery Team Lead

This is a fully remote position, open to applicants in Texas.

📋 Description

• Evaluate and oversee claims audit data across various platforms.

• Organize and prioritize daily work tasks for staff to ensure timely and precise processing.

• Perform quality audits and claims processing across departments.

• Decrease response times and reduce inquiries or escalations through proactive problem-solving.

• Establish team standards and deadlines, assess results, and offer constructive feedback.

• Inspire team performance and uphold morale through accountability and leading by example.

• Assist leadership in managing complex information from financial, clinical, and operational systems.

• Aid in pricing claims based on provider contracts.

• Facilitate the resolution of customer complaints, inquiries, and bill review disputes.

• Identify and track workflow barriers and account details.

• Implement process enhancements and initiate actions for problem resolution.

• Analyze Revenue Cycle transactions and deliver trend analysis.

• Generate daily, monthly, and annual evaluative and statistical reports.

• Assess client data integrity and support Product and Account Management teams.

• Engage in panel interviews, new-hire documentation, associate orientation, and termination processes.

• Lead designated initiatives and coordinate task teams or forums.

• Review case rates, per diems, discounts, charges, and costs associated with claims.

• Address escalated requests from clients and executive leadership.

• Support research and development projects, process documentation, training, quality audits, and surge activities.

• Uphold strict confidentiality of medical records, PHI, and PII.

⛳️ Requirements

• Over 5 years of relevant experience in the medical or insurance sector, with significant involvement in bill review processing of claims.

• A minimum of 3 years in supervisory, management, or project management roles is advantageous.

• At least 3 years of relevant experience or an equivalent mix of education and work experience.

• A High School Diploma or higher is preferred.

• Proven knowledge of CMS guidelines and ICD-10 coding guidelines as applicable.

• Comprehensive understanding of payment reimbursement methodologies.

• Solid understanding of claims processing workflows.

• Strong grasp of ICD-10 coding principles.

• Familiarity with DRG Validation, if applicable.

• In-depth understanding of the healthcare revenue cycle and claims reimbursement processes.

• Proficient in MS Office, including Word, PowerPoint, Excel, and Outlook.

• Knowledgeable in the Windows operating system and internet usage.

• Excellent analytical and problem-solving capabilities.

• Exceptional attention to detail.

• Ability to work autonomously and engage in critical thinking.

• Strong interpersonal skills and an adaptable communication style.

• Capacity to think and operate independently within a team setting.

• Capability to maintain confidentiality regarding medical records, PHI, and PII.

🏝️ Benefits

• Medical (HDHP) w/Pharmacy

• Dental

• Vision

• Long Term Disability

• Health Savings Account

• Flexible Spending Account Options

• Life Insurance

• Accident Insurance

• Critical Illness Insurance

• Pre-paid Legal Insurance

• Parking and Transit FSA accounts

• 401K

• ROTH 401K

• Paid time off

• Opportunities for career advancement

• Supportive workplace culture