Team Lead, Provider Data Claims Support (Provider Data Experience Preferred)

Job Summary:

The Team Lead, Provider Data Claims Support performs supervision and support of the Provider Data Claims (PDCS) team.

Essential Functions:

• Responsible for accurate and timely processing of provider additions, terminations, and changes to meet regulatory requirements and maintain provider panel information for CareSource products
• Monitor level of inventory; notify management of levels outside of established thresholds
• Create and update ongoing staffing plan to address issues that may impact service or provider/internal customer satisfaction
• Coordinate efforts with Health Partner Reps and department peers to complete all missing components
• Continuously monitor all work queues to ensure Turn Around Times (TAT) are being met
• Actively participate in PDCS meetings as appropriate
• Assist with hiring and oversee orientation and training of new hires
• Maintain time sheets for non-exempt employees
• Coordinate pended claims and mailbox activities related to assignments, problem solving, and project management
• Supervise staff for quality review, performance feedback, disciplinary issues, and merit/bonus appraisal review
• Create, review, revise, and enforce company and departmental policies and procedures
• Provide mentoring, training, and ongoing education in regards to optimal performance and Standards of Excellence
• Responsible to ensure all pended claims are submitted for processing through XC have the correct Member and Provider to properly adjudicate through FACETS.
• Collaborate with business partners and senior leadership to prioritize data-driven projects, and to provide claim information to support business processes
• Contribute to business process improvement through comprehensive requirements to resolve pended claims
• Perform any other job related duties as requested

Education and Experience:

• Associates Degree or equivalent years of relevant work experience is required
• Minimum of three (3) years of healthcare experience is required
• Minimum of two (2) years of claims processing and/or provider load experience is required
• Previous supervisory/leadership experience preferred
• Healthcare, claims, technology and ticket application experience is preferred

Competencies, Knowledge and Skills:

• Working knowledge of medical claims workflow and processing applications
• Healthcare insurance knowledge
• Knowledge on SQL desirable
• Knowledge of managing inventory and assigning work
• Knowledge of medical coding (CPT, HCPCS, ICD)
• Advanced working knowledge of managed care and health claims processing and provider load processing
• Ability to track/trend provider load and claims processing issues and develop solutions
• Excellent communication skills; both written and verbal
• Time management skills; capable of multi-tasking and prioritizing work
• Effective decision making / problem solving skills
• Knowledge of regulatory reporting and compliance requirements
• Excellent listening and critical thinking skills
• Proficiency in Microsoft Suite to include Word, Excel and Access
• Computer skills and abilities in Facets or equivalent claims adjudication system
• Ability to identify and recommend process improvements
• Ability to effectively interact with all levels of the organization

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:
$60,300.00 - $96,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.