Job Summary The Appeals Team Lead is responsible for performing daily appeals follow-up, monitoring denial trends/issues and assisting the Appeals Manager with training of the appeals department.
Supervisor Appeals Manager
Duties (included but not limited to):
Provides introductory and ongoing training and education to all Appeals staff to ensure that policies and procedures are followed
Meets with the Manager regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes
Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards, including performing QA reviews for staff
Maintains established departmental policies and procedures, objectives, patient and customer service policies
Assists with payroll activities for team members (i.e. edit sheets)
Assists manager with development and implementation of project and department action plans
Monitors insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons
Identifies coding or clinical documentation issues and work to correct the errors in a timely manner
Identifies problem accounts and/or trended issues and escalates as appropriate
Updates the patient account record to identify actions taken on the account
Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
Performs other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES
Organization - proactively prioritizes needs and effectively manages resources
Communication - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.
Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Interpersonal skills - able to work effectively with other employees, patients and external parties
PC skills - demonstrates proficiency in Microsoft Office applications and others as
training, advice and feedback to assist/support employees in achieving established
recommendations for changes/adjustments as needed during the implementation or
change to new products or processes
policies, procedures and systems
accurately in short timeframes, have ability to work quickly and accurately in a fastpaced
environment while managing multiple demands, ability to work both
independently and collaboratively as a team player, adaptability, analytical and problem
solving ability and attention to detail and able to perform basic mathematical
calculations, balance and reconcile figures, punctuate properly, spell correctly and
High School diploma or GED required.