This team lead position is responsible for supporting management in leading a team in analyzing and resolving claims with overpayments timely. The team lead is responsible for day to day support of the teams tasks, training needs, identifying trends with possible solutions, testing, documenting and training new system functionality, training of new hires while maintaining current knowledge of payor policies/guidelines. This position will work with other departmentsthroughout the organization on process improvement, participate in operational meetings including but not limited representing the team and trends presenting claim processing issues. Strong knowledge of payor requirements in overpayment resolution is required.
Monitors accounts for timely follow-up and prompt resolution of overpayments following payor guidelines.
Supports the team in day to day responsibilities and inquires.
Assists in continuously improving outstanding credit A/R while minimizing controllable loss categories (i.e. Timely filing).
Ensures incoming overpayment inquiries are processed timely.
Monitors and ensures correspondence is processed timely.
Ensures that all written responses are clearly and professionally communicated.
Performs staff quality reviews, identifying training needs while communicating with management of on-going staff overpayment processing concerns.
Strong knowledge of all major healthcare payors policies/guidelines on overpayment resolution including but not limited to timely filing guidelines.
Working withpatient accounts, resolving both insurance and patient credit balance within payor guidelines.
Understanding, verifying insurance coverage, updating insurance coverage and claim submission as needed.
Reviewing payor remits to determine how to appropriately resolve overpayments.
Contacting payors as needed to allow credit resolution including attending payor operation meeting to represent payor/provider ongoing claims/payment processing concerns.
Monitors WQ volumes and aged overpayments.
Assisting in overpayment recovery audits.
Reports on and communicates staff productivity measures.
Seeks process improvement/efficiencies.
Reviews high dollar insurance and patient refunds.
Ability to work all payor overpayments to resolution.
Update and maintain processes for the refunds team.
Train new hires and ongoing training for the team as needed.
Perform testing, documenting and training of new system functionality.
Identify trends and system breaks with examples and possible solutions.
Work leadership, attending meetings, problem-solving as needed.
Knowlege of professional and facility biling, claim processing and overpayment resolution.
4 or more year in an office clerical setting, of which 3 years experience in a hospital or clinic business office processing medical claims and overpayment resolution
Strong knowledge of all major insurance healthcare plans
2 years Epic experience
1 year in a team lead role or similar such as training, process improvement or being a point person knowledge expert
Fluent in Windows Applications
1 year minimum medical account overpayment resolution
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.