Position: Team Lead, Encounter Reimbursement
Department: Claims
Reports to: Supervisor, Claims
Position Description:
The Team Lead acts as the subject matter expert for Provider Contracts/Encounter analysts within the team while reporting all contracts/encounter records within the SLAs for each Payor. TL acts as a liaison between the Supervisor and employees of the team. TL maintains and ensures compliance within the team with applicable laws and regulations and the policies of tango.
Office Location:
- Office located at 7600 North 16th Street, Suite 140 Phoenix, AZ 85020 (Remote)
Responsibilities and Duties:
- Main point of contact for Claim Encounters/Reimbursement team.
- Actively participates in external/internal data encounter meetings and escalates to Director of Claims as appropriate.
- Oversees processing of data encounters and entering fee schedules etc., reimbursement methodology in accordance with policies and desktop procedures.
- Ensures data encounter rejections are corrected and reported by the contract language in accordance to the SLAs per health plan.
- Track/Trend encounter results and provide solutions and implement enhancements to improve 1st time encounter acceptance records.
- Strong analytical skills.
- Oversee any open systemic tickets with appropriate vendors (Plexis, SDS, any encounter clearinghouses etc.) when modifications to file layout are requested, or new requests are received.
- Implement testing protocol when new encounter configurations take place.
- Support employee quality and productivity training, as identified on audits, encounter reporting, transmission log reporting or productivity reporting.
- In conjunction with the Training team, train and mentor new employees within the team to ensure on-time requirements can be met without loss of efficiency.
- Report promptly to team Supervisor when delays are identified.
- Coordinate with the Supervisor and the Training team to assist with draft updates to process materials desk top procedures as changes in process are required.
- Run team reports as requested.
- Share with Supervisor employees that require frequent support for retraining opportunity.
- May be assigned to fill in for Supervisor when required, to ensure appropriate scheduling of team members for day-to-day production coverage.
- Manage encounter files in production; SLA’s per HealthPlan, overall monitoring of encounter transmission logs, inbound/outbound response files as well as attestations on external/internal audits.
- Other duties as assigned.
Qualifications:
- Some College or equivalent experience in Health Information Management (HIM), or business administration required
- 3-5 years’ experience in:
- Medicare/Medicaid managed care
- Encounter data processing and claims data submission
- Healthcare data Analytics or Data Quality Assurance
- Using Health Plan Platforms (Optum, Finthrive, Availity etc.)
- Applying or Maintaining Fee Schedules in accordance with in/out of network provider contracts
- Experience with CMS encounter data submission standards
- Familiarity with 837 file formats, EDI transactions and other claim formats
- ICD, CPT, HCPCS coding systems
- Self-Sufficient in Excel, Power BI, Notepad++
- Strong analytical thinking and problem-solving
- Good communication/leadership skills
Proven Personal Attributes:
- Ability to multitask in a fast-paced work environment.
- Ability to remain calm under pressure and manage stressful situations.
- Ability to maintain a high level of confidentiality and remain HIPAA compliant.
- Ability to establish highly productive and detailed organizational skills/habits.
- Ability to motivate others and project a positive attitude.
Job Type
- Full-time
- Remote - United States
tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.