TL - HC vertical - Pune

Job Description:

Job Description

Note:

• Candidate should be an On Paper Team lead and have experience in Attrition Calculation, Capacity Calculation, People Management (Must)
• Candidates should have Good Communication (Must)
• Candidates should have experience in Claims Healthcare (Must)
• Check with the candidates if they are able to speak on Attrition calculation and Capacity Calculation and able to explain Roles and Responsibility of Team Lead (Must)

PFB Job Description:

PROCESS:            Claims Processing

JOB TITLE:            Team Leader

ROLE: Manages and supervises the Claims Team to ensure claims are paid properly and timely in accordance with Regulatory standards, Health Net standards, and contractual obligations, ensures that all policies & procedures are met. Identifies problem areas such as understaffing, customer complaints/issues, inefficiencies, and takes corrective action. Coordinates and manages projects/programs for present and future department development. Analyzes work processes, systems and make recommendations for improvements. Handles all personnel related duties such as counseling, interviewing, performance review, hiring and terminations. Provide timely monthly reports on claims payment and inventory.

REPORTING TO                                 : Team Manager

ESSENTIAL QUALIFICATION         :

• Bachelor's degree required (preferably in Sciences)
• 6 to 8 years of relevant Domain experience / Industry experience
• Existing Team Leader Managing ~20+ Production associates & SMEs
• Thorough knowledge of medical terminology, enrollment and membership activities, claim processing procedures/systems, auditing, and a thorough understanding of claim protocols and industry standards and CMS regulations as it relates to claims payment and compliance.
• Knowledge and work experience with ICD9, ICD10, CPT and different coding systems (preferable)
• At least 2-3 years prior claims processing experience in Managed Care / Government funded products related setting in a lead or supervisory capacity.
• Supervise others by assigning/directing work; conducting employee evaluations; staff training and development; coaching and counseling.
• Effective oral and written communication skills.
• Ability to assess and coordinate departmental workflows effectively 

ESSENTIAL SKILLS/PERSONALITY TRAITS:             

• Good Communication Skills – Both Verbal and Written.
• Eye for Details.

• Logical thinking.
• Analytical Skills.
• Professional demeanor.
• Ability to work with limited supervision.
• Ability to multi-task and manage time efficiently under the pressure of deadlines.
• Sensitivity to the confidential nature of the data and proprietary company information.

• Good Leadership skills (Leader without Title).

OPERATIONAL RESPONSIBILITY:

• Manage a team of ~25 Direct reports  and be accountable for Delivery, customer & people management
• Acts as the customer point of contact/liaison regarding operational issues, including provider meetings, claims issues, projects and ad hoc operational sessions. Implements policy changes as needed to insure continuing client focused operational responses.
• Responsible for internal and customer initiated audits and regulatory reviews. Interfaces with customers on issues of operational functions, research and analysis of client/provider issues.
• Tracks progress, follows up on audit results and ensures changes/recommendations are initiated.
• Responsible for meeting established contractual operational standards, departmental standards, goals and deadlines.
• Reviews and analyzes reports, records and directives and confers with Team Manager to obtain data required for planning. Establishes procedures for maintaining high standards of operations, product and specific-focus on quality.
• Responsible for planning and analyzing claims check runs on a weekly or as needed basis.
• Responsible training examiners on latest claims regulations and reimbursement schemes
• Assist in analyzing encounter data submission errors.