RCM Team Lead (KHS)

The RCM Team Lead is responsible for managing designated clinic medical claims processing, payment posting and follow up. This position works with the computerized practice management system for the validation, submission, and processing of insurance and self-pay claims. The position is responsible for collecting and entering claim information, validation, and correction of rejected claims, and claim submission to payers for reimbursement.

The RCM Team Lead also assigns and monitors workload and process workflow for an assigned group of employees. This position also provides continual education and on the job training to staff as areas of opportunity are identified. The lead will work closely with management to set monthly goals, key performance indicators, monitor performance, and provide feedback up and down the department chain. This position is a key change agent in identifying opportunities for improvement within the claims processing workflow for revenue cycle.

Responsibilities :

• Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information.
• Ensures claim information is complete and accurate.
• Review insurance claims submitted to clearinghouse or individual insurance companies electronically or via paper CMS- form or UB.
• Follows up with insurance company on unpaid or rejected claims.
• Resolves claim issues.
• Experience with MDI / Nextgen.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial.
• Collects necessary information to accompany appeal.
• Provides necessary information to collection agencies for delinquent or past due accounts.
• Compiles data for trending of errors and rejected claims.
• Serves as a resource for claims analyst and account representatives.
• Directs daily operational tasks to ensure completion and adhere to policy and procedure to achieve set KPI goals.
• Reviews at random claims per employee for audit purposes each week and provides feedback to each employee on the findings.
• Responsible for producing productivity reports and sharing them with the team on a weekly basis.
• Creates reports of compiled data to present to leadership for issue escalation and resolution.
• Possesses the ability to work in a constantly changing work environment and emphasis on attention to detail.
• Ability to work collaboratively within the department and organization.
• Ability to maintain confidentiality.
• Ability to work independently and remote as needed.
• Must have excellent organizational skills and the ability to prioritize and coordinate workload with a high degree of proficiency and accuracy.
• May perform other duties as assigned or requested and job specification can be modified or updated at any time.

Qualifications :