Reimbursement Team Lead

Purpose

The Reimbursement Team Lead is responsible for overseeing and managing the reimbursement processes and team members within an organization.

Responsibilities

• Effectively track and assist recording of the On Boarding forms for the signed providers
• Maintain Master OB Tracker
• Communicate any changes to providers, resend, edit and email necessary documents each quarter with changes
• Report and track Medicaid Fee Schedules by state for Extremity Care products
• Assist IVR team as needed on prior authorization follow up
• Research the “pending auth” cases to document if process was followed for reimbursement
• Assist in developing and writing process and procedure manuals for department
• Research and respond to unusual or complex reimbursement scenarios assisting in appeals processes and requirements
• Assist providers with understanding of EC billing guides and the claim process
• Assist with daily distributor emails and provider inquiries
• Experience with payer websites, electronic clearinghouses, Availity
• Special projects, as assigned
• Maintain a working knowledge of FDA 21 CFR 1271, FDA 21 CFR 820, AATB standards, ISO Standards, cGMP/CGTP, other relevant regulations/standards, and internal organizational policies and standard operating procedures.
• Manage direct reports.
• Provide constructive feedback and guidance to develop leadership in direct reports and department management.
• Establish and monitor objective annual goals for direct reports.
• Conduct performance reviews and establish performance improvement plans as needed.
• Recruit, interview, and select personnel for hire.
• Maintain acceptable attendance and punctuality for scheduled work hours and meetings. Ensure completion of assigned tasks and responsibilities within defined timeframes.
• Flexibility to work outside of normal business hours during weekdays or weekends with reasonable advance notice to support business/operational needs when necessary.
• Perform other duties as assigned.

Skills

• Ability to interpret medical benefits, EOBs, appeal letter responses from payers
• Must have attentive to detail, accuracy and must possess organizational skills
• Excellent communication and documentation skills required
• Ability to discuss claim issues with providers, medical staff, and sales personnel
• Solid understanding of Medicare LCDs and commercial medical policies
• Knowledge of CPT, HCPCS, and ICD10 coding and medical terminology
• Ability to work independently and in a team environment
•  Excellent attention to detail and organization
• Excellent written and verbal communication
• Highest level of ethics and integrity
• Ability to lead and motivate the right behaviors
• Ability to multi-task and work in a fast-paced environment
• Strong technical writing
• Effective project management
• Proficiency in Microsoft Office

Qualifications/Requirements

• Bachelor’s degree in business or related field, from an accredited college or university required.
• At least 3 year(s) of experience in medical billing, reimbursement, revenue cycle management or related field required.
• Associate’s degree (or 60 credit hours) may be substituted to meet up to 2 years of experience requirements.
• Bachelor’s degree may be substituted to meet up to 4 years of experience requirements.
• Master’s degree may be substituted to meet up to 6 years of experience requirements.
• Clearance of favorable background investigation required.