The Claims Team Lead provides training/development, consultation, and direction to Claims Research Analysts and collaborates with Claims leadership and other departments to improve claims processes and Claims system changes. The Claims Team Lead also facilitates peer reviews and independent claims audits to identify areas for improvement and correction. The position provides guidance and training/technical assistance to network providers in an effort to strengthen the performance of Alliance Behavioral Healthcare’s provider partners. This position creates reporting tools to aid in identification of areas needing attention and to communicate performance.
This position will allow the successful candidate the ability to work remote certain days of the week. The employee will be required to come into the Home office (Morrisville, NC) on certain days as approved by their supervisor.
Responsibilities & Duties
Provide Guidance and Consultation to Claims Research Analysts
Assist the Claims Research Analysts in reviewing claim errors
Provide daily consultation to Claims Research Analysts to resolve processing issues
Facilitate monthly peer reviews
Ensure staff is taking the appropriate steps even when it may require escalation for resolution
Role model professional communication and conduct at all times
Provide Training and Development to Claims Research Analysts
Onboard and train new claims staff
Provide ongoing in-person and virtual learning opportunities to include 1:1 training, shadowing, provision of routine feedback
Provide claims processing training for new and existing staff
Provide Training/Technical Assistance/Resolutions to Providers
Facilitate in-person and virtual claims processing training for providers
Provide technical assistance on claims processing issues to providers
Research provider concerns or complaints and resolve. Escalate complaints to grievance team when appropriate
Analyze Data and make recommendations
Review and analyze daily, weekly and monthly reports to help track processes and recommend procedure and process changes to increase productivity
Review claims production and quality levels for performance and monitor Provider/Member feedback. Refer areas of staff performance concerns to supervisors
Monitor and record performance measures and compile performance reports
Improve Quality of Claims Processing procedures and performance
Develop and implement approved new and updated procedures and desk references to improve quality and performance
Stay abreast of related regulatory, compliance and departmental updates to meet departmental metric requirements
Collaborate with Contracts, Credentialing, Enrollment, Provider Network teams to assist providers with successful claims submissions
Maintain a working knowledge of Provider Network functions to appropriately advise/guide providers with claims-related issues
Collaborate with Utilization Management to resolve and manage system changes to allow for successful claims adjudication
Provide backup coverage to supervisory staff as needed
Support Expansion and New Business
Learn new skills related to expansion and new business requirements per Alliance Health contracts. This includes: coverage of additional catchment areas, new covered services, processing and handling of physical health claims
Education & Experience
Required:
High school diploma or equivalent and four (4) or more years of experience processing behavioral and physical health claims and analyzing claims processing data
Preferred:
Experience leading a team and conducting trainings and presentations
Knowledge, Skills, & Abilities
Claims Processing- Behavioral, Physical
Training/Presentation
Microsoft Office Package
Communication- Verbal
Organization
Complex Problem Solving
Time Management; Prioritization
Customer Service; Interpersonal Relationships
Written Communication; Reporting
Salary Range
$25 -$28.75/Hourly
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
