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About the role
Key responsibilities & impact- Maintain HIPAA/PII guidelines to ensure the confidentiality of all calls and documents
- Serve as a liaison between departments, vendors and clients to ensure collaborative progress
- Exhibit strong working knowledge of customer business operations
- Demonstrate strategic business acumen in decisions affecting bottom line focus
- Generate and deliver accurate and timely reports
- Assist with troubleshooting for technical issues
- Serve as a role model in demonstrating core values of customer service
- Encourage continuous learning, personal development and accountability through team members
- Provide timely and thorough responses to internal and external customers
- Respond to member and group correspondences regarding plan/guideline or claim questions within 24 hours
- Escalate difficult issues to the appropriate channels
- Assist in the processing and resolution of escalated issues
- Ensure team compliance with service standards
- Follow trends within assigned scope and alert appropriate parties of any trends that fall outside quality parameters
- Develop and execute plans to meet established goals
- Provide continuous feedback to strengthen and optimize quality performance
- Work cross-departmentally to improve or streamline procedures
- Maintain up to date knowledge on industry trends and look for new data sources
- Develop new and improve current internal processes to improve overall quality
- Conduct regular performance evaluations of employees and provide ongoing feedback and coaching as necessary
- Address and counsel employees on behavioral or performance problems and implement corrective action as necessary
- Explain and administer company policies required for team members to perform duties successfully
- Distribute and monitor departmental workloads to ensure adequate coverage while meeting quality and service levels
- Oversee new and ongoing training and update training manuals
- Coordinate and actively participate in departmental meetings
Requirements
What you’ll need- College degree or equivalent required
- Degree in Medical Billing and Coding or related field preferred
- Knowledge of medical terminology preferred
- 7 -10 years Claims Examiner experience or equivalent required
- 4 -7 years management experience required
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical billingcodingclaims examinationreport generationtroubleshootingperformance evaluationprocess improvementdata analysiscustomer servicecompliance
Soft Skills
strategic business acumencollaborationcommunicationleadershipcoachingaccountabilityproblem-solvingfeedbackadaptabilityteamwork
Certifications
college degreemedical billing and coding certification