Billing Claims Team Lead (Remote) 2024-1327

Position Title: Billing Claims Team Lead (Remote) 2024-1327

Location: Dublin, OH, USA

Job Category: NPN Operations

Job Type: Full Time

Description:

Billing Claims Team Lead

Salary Range: $60,000 - $70,000 depending on experience and qualifications.

?Overview

Are you energized by working in a fast-paced document management center and making a difference in the lives of members of the World Trade Center Health Program? Do you have excellent communication skills, strong supervisory, billing claims management, and organizational skills, and want to be part of an organization where caring truly counts? Join our team of caring colleagues and help us make a difference in the lives of those, specifically survivors and the brave responders, directly affected by the September 11th terrorist attacks.

As a Bill Review Team Lead, you will work remote in your home office supervising bill processors and implement timely cost-effective fee management services in compliance with corporate/jurisdictional standards; to provide review of technical, complex claims requiring extensive skills/experience; and to interact with bill processors, utilization review nurses, and claims staff to resolve problems and/or implement and improve workflow and communication. This position assures that claims information is expedited and properly loaded and is a liaison communicating with member services to resolve document problems and/or questions.

Bill Review Team Lead Responsibilities

• Performs senior position duties, including one or more of the following: train bill processors; organize and assign workload; monitor performance; manage performance reviews; and assist with complex bill reviews.
• Reviews and maintains standards of inventory management, turnaround expectation, and customer satisfaction expectations.
• Works directly with reviewers to assure effective results through skilled, efficient services.
• Maintains knowledge and familiarity with corporate quality standards; ensures consistent application.
• Assures maintenance of productivity standards within acceptable error rate.
• Reviews bills using experience-gained knowledge of fee schedule and medical terminology; maintains knowledge of all bills regardless of complexity of claims, levels of service, or multiple jurisdictions.
• Ensures good results to our customers; provides quality customer service in oral and/or written communication.
• Develops and maintains tracking and quality assurance reports; obtains and reviews operational reports; and develops and implements operational revisions as necessary to improve service or unit efficiency.
• Acts as liaison between claims staff, nursing staff, medical bill payment team, and bill processors.
• Responds to written or verbal requests from vendors, insurance carriers, legal representatives, and members by preparing documentation; may assist in preparing case testimony.
• Participates in group meetings and training sessions.
• Performs other duties as assigned.

Bill Review TL Qualifications

• Bachelor’s degree from an accredited college or university is preferred.
• Six (6) years of experience in medical claims processes with experience in state regulatory issues for payment of medical claims or equivalent combination of education and experience required.
• Knowledge of legislative environment and the market place
• Good customer service skills
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiation skills
• U.S. Citizenship
• Must be able to obtain a security clearance

For a career path that is both challenging and rewarding, join Sedgwick Government Solution’s talented team. Taking care of people is at the heart of everything we do. Our clients depend on our talented colleagues to take care of their most valuable assets—their employees, and their customers. At Sedgwick Government Solutions, caring counts®. Join our team of creative and caring people and help us make a difference in the lives of others.

In addition to a competitive salary, comprehensive health and welfare benefits, tuition reimbursement, and incentive compensation, Sedgwick Government Solutions offers participation and vesting in a 401(k) plan with a company match. If you would like to contribute to our important mission and work collegially in a professional organization that values intelligence, integrity, and initiative, consider a career with Sedgwick Government Solutions.

To be considered for this position, please submit a resume, and complete the application.

The information provided above has been designed to indicate the general nature and level of work of the position. It is not a comprehensive inventory of all duties, responsibilities, and qualifications required.

Important Information

Successful candidates will be required to undergo a financial and criminal background check and obtain and maintain confidential-level security clearance upon hire. We participate in the United States Federal Government E-Verify program to confirm the employment authorization of the employee upon hire.

Search Firm Representatives

Please be advised that Sedgwick Government Solutions (Government Solutions) is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, a valid written agreement and task order must be in place before any resumes are submitted to Government Solutions. All resumes submitted by search firms to any employee at Government Solutions without a valid written agreement and task order in place will be deemed the sole property of Government Solutions and no fee will be paid in the event that person is hired by Government Solutions.

Government Solutions strives to make our career site accessible to all users. If you need a disability-related accommodation for completing the application process, please contact Government Solutions regarding accommodations.

Sedgwick Government Solutions is an Equal Opportunity and Affirmative Action Employer

All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, disability, marital status, national origin, race, religion, sex, sexual orientation, gender identity, veteran status, or any other classification protected by federal state or local laws as appropriate, or upon the protected status of the person’s relatives, friends or associates.

Sedgwick Government Solutions abides by the requirements of 41 CFR 60-741.5(a). This regulation prohibits discrimination against qualified individuals on the basis of disability and requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified individuals with disabilities.

Sedgwick Government Solutions abides by the requirements of 41 CFR 60-300.5(a). This regulation prohibits discrimination against qualified protected veterans and requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified protected veterans.

About Sedgwick

Sedgwick Government Solutions is a fully owned subsidiary of Sedgwick. Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. The company provides a broad range of resources tailored to clients' specific needs in casualty, property, marine, benefits, and other lines. At Sedgwick, caring counts; through the dedication and expertise of more than 27,000 colleagues across 65 countries, the company takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact the bottom line. www.sedgwick.com

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