Healthcare Operations Support Specialist Lead

Job Description: • Serves as first point of escalation for questions and issues on the team • Use good judgment to inform and/or escalate to management as may be appropriate • Leverage knowledge and acumen in the medical billing and claims industry to provide actions-based solutions for clients, and answer staff questions • Assists in the gathering of information, data points, and current reporting tools to resolve any conflicts or concerns of claim discrepancies • Responsible for ensuring that regular data reporting from the team for internal business groups and for clients are delivered in accordance with schedule and scope • Coordinates and follows-up with audit groups to monitoring data flow coming from selection team • Inform appropriate management and audit team members as appropriate for delays or issues • Reviews incoming requests for Ad Hoc reports, from varying resources, and assessing the skills and capabilities of the team, assigns the creation of the report to the employees • Creates and delivers scheduled and ad-hoc reporting on-time and with high quality • Contributes to special ad hoc report creation and analysis to create effective resolutions for client requests, inventory monitoring and management, medical records request letters, and other time sensitive work product • Monitors claim and case inventory reports and utilizes industry knowledge and company procedures to effectively assign case inventories to meet daily, weekly, and monthly work product objectives • Requests insights drawn from DPE spreadsheet queries, working with excel filter tools, and knowledge of DPE reporting to extract and assign needed • Provides some basic analytic review in event of client escalates concerns on re-pricing initiatives or determinations, and the client seeks solutions from data reporting • Participates in weekly and monthly communication and service focused meetings both internally with staff and as a knowledge participant for client calls, building working relationships of trust and reliability with client(s) • Responsible for reporting meeting outcomes, minutes, and accomplishments applicable to the team • Responsible for the on-the-job training of staff on work processes and tasks, standard operating procedures, system proficiency, and changes as applicable based upon internal or client requirements • Contribute to the development and/or improvement and administration of team productivity and Quality Assurance metrics and procedures • Monitor activity volume and staff capacity to ensure resources are aligned with business needs • Provide insights to management as may be needed for staff or workflow planning • Review team and individual productivity and quality against established metrics and identify potential issues or gaps, making recommendations to applicable supervisor or management on performance improvement needs • Other Duties as assigned Requirements: • High school degree or GED required • Some college, AS or BS degree is plus • Minimum 3 years of experience involving medical billing/claims required • Six (6) or more years preferred • Well-rounded knowledge and skills specific to the medical claim billing, medical terminology, medical coding, re-pricing claims • Experience in some capacity of medical claim quality assurance, or past demonstrated experience in a QA function • Strong working proficiency with Microsoft Office suite • Must have strong Excel skills and demonstrated ability to effectively leverage a multitude of templates, formats, and data spreadsheet tools • Strong technical skills – comfort working with databases and tools to extract and analyze data • Previous experience with various database tools such as DPE and others to organize information and reporting into value added work product • Ability to communicate professionally both verbally and in written form with internal and external audiences • Good critical thinking, questioning, and listening skills. • Time management skills to effectively manage diverse workload while completing work within allocated time frames in a fast-paced dynamic environment. • Must have excellent organization skills and attention to detail. • Ability to work independently, and work cooperatively within the team, providing strong understanding of workflows, claim escalations, reporting tools, and team training. • Demonstrated ability to lead by example for operations staff demonstrating integrity, reliability, strong initiative and work ethic, work attendance, problem solving, and organization of work. • Can meet objectives with minimal supervision. Benefits: • medical • dental • vision • HSA/FSA options • life insurance coverage • 401(k) savings plans • family/parental leave • paid holidays • paid time off annually