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Eligibility Lead in Los Angeles, CA at TeamHealth

Date Posted: 11/18/2018

Job Snapshot

Job Description

Join a team of dynamic, results oriented professionals!

Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review

  • Career Growth Opportunities
  • Convenience market on site
  • Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
  • 401K program (Discretionary matching funds available)
  • Employee Assistance Program
  • Referral Program
  • Dental plans & Vision plans
  • GENEROUS Personal time off
  • Eight Paid Holidays per year
  • Quarterly incentive plans
  • Business casual dress code
  • Free Parking
  • Free coffee daily
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Awesome Facility with terrific amenities
  • Wellness programs
  • Flexible work schedule

JOB DESCRIPTION OVERVIEW:

Under general supervision, the Registration Eligibility Lead is responsible for having working knowledge of payer contracts, payer/billing guidelines, resolving payer issues and performing quality audits. This position distributes, communicates, and organizes workloads within the Eligibility Department. The Registration Eligibility Lead directs the day to day education of all employees on department processes. This position deals directly with employees to resolve work related issues and monitors performance to advise manager of any deficiencies. The position works in a cooperative team environment to provide value to customers (internal or external). The Registration Eligibility Lead carries out his/her duties by adhering to the highest standards of ethical and moral conduct, and acts in the best interest of TeamHealth. This individual exercises independent judgment in key decision-making processes.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Responsible for having working knowledge of payer eligibility and benefits verification/billing guidelines.
  • Assisting in identifying and resolving payer trends and issues related to eligibility & billing denials and rejections.
  • Ensures department is current and meets departmental performance indicators/goals.
  • Responsible for monitoring daily workloads and timely completion of the work by the Eligibility Representatives.
  • Responsible for assigning/organizing projects (internal/payer) to Eligibility/Registration Representatives or Billing Center (if needed) and ensuring the projects are completed timely and accurately.
  • Coordinates with and provides feedback to management regarding process improvements, trends, errors or issues as they relate to the registration department.
  • Responsible for employee training, answering employee questions/resolving issues, performing quality audits and providing feedback on performance in a timely manner.
  • Responsible for running daily/weekly reports to determine workloads, quality, trends, and preventive measures for the department.
  • Responsible for completing Lead assignments in a timely manner, as scheduled.
  • Responsible for conducting employee staff meeting and has the ability to speak to large groups.
  • Ability to navigate and use facility access to obtain factsheets as needed for various processes in the department.
  • Monitors employees’ performance (including production, quality of work, etc.) and advises Manager of any deficiencies.
  • Assist in monitoring employees’ obedience to TeamHealth policies and procedures and advises Manager and HR of any issues or concerns.
  • Responsible for working/assisting other department Leads/Mangers with inquiries.
  • Communicates with customers to resolve inquiries/issues (patients, payers, vendors, regional offices, other billing center departments, etc.) in a timely and professional manner.
  • Ensures compliance with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care and self-pay payers.
  • Maintains ongoing knowledge of HCFA 1500 and other mandatory state billing forms and filling and follow up requirements and ensures compliance of CPT, HCPCS and ICD-9/ICD-10 coding regulations and guidelines.
  • Continually seeks to understand and act upon customer needs, concerns, and priorities. Meets customer expectations and requirements, and gains customer trust and respect.
  • Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
  • Demonstrates ongoing enthusiasm and commitment to the work assigned.
  • Participates in a process to continually improve organizational effectiveness using self-assessment performance evaluation criteria.
  • May perform special assignments and other related tasks as assigned.
  • May perform a follow up on outstanding AR in order to meet department’s performance goals.

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Normally, the knowledge, skills and abilities necessary for adequate job performance can be obtained through approximately Five+ years’ experience with insurance denial and correspondence processes within a multi-facility environment.
  • In addition, working knowledge of insurance carriers’ payment regulations including various reimbursement schemes, coinsurance, payer and billing guidelines, deductibles, and contractual adjustments is necessary as well as significant working knowledge of the insurance process, denials, appeals and insurance eligibility, and HIPPA guidelines and laws.
  • Advanced knowledge of Microsoft Excel.  
  • Also, demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary.
  • Experience with providing visible participation and support of major change initiatives preferred.
  • Some college coursework in business administration or accounting preferred.
  • Some supervisor experience is helpful.
  • Knowledge of Microsoft Excel, Word, and PowerPoint is preferred.
  • Ability to operate a computer efficiently and accurately.
  • Ability to operate various office machines (i.e., fax, copier).
  • Knowledge of basic math and the ability to perform math functions in units of American currency.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.
  • Ability to think analytically, conceptually, and systemically; to synthesize complex or diverse information; collect and research data, draw valid conclusions, and make appropriate project decisions.
  • Ability to write, speak and listen well and appropriately with different audiences.
  • Able to write reports, business correspondence, and other documentation materials.
  • Able to present information and respond to questions from groups of managers, clients, customers.
  • Ability to review documents for accuracy and reasonability.
  • Ability to determine priorities.
  • Ability to handle multiple tasks & meet deadlines within standards. Excellent organizational skills.
  • Ability to work within a team environment as well as unsupervised.
  • Ability to coordinate schedules and information.
  • Ability to conduct mathematical and statistical analysis
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.
  • Ability to think analytically, conceptually, and systemically; to synthesize complex or diverse information; collect and research data, draw valid conclusions, and make appropriate project decisions.
  • Ability to write, speak and listen well and appropriately with different audiences.
  • Has complete understanding and working knowledge of navigating payer websites.
  • Able to write reports, business correspondence, and other documentation materials.
  • Able to present information and respond to questions from groups of managers, clients, customers.
  • Ability to review documents for accuracy and reasonability.
  • Ability to determine priorities.
  • Ability to handle multiple tasks & meet deadlines within standards.
  • Excellent organizational skills.
  • Ability to work within a team environment as well as unsupervised.
  • Ability to coordinate schedules and information.
  • Ability to conduct mathematical and statistical analysis
  • Ability to communicate effectively orally, in person and on the telephone, and in writing, with individuals at all levels, both within and outside the company.
  • Knowledge of health insurance eligibility verification requirements and processes.
  • Knowledge of health care industry and various payers’ guidelines and policies (Medicare, Medicaid, Commercial, HMO, PPO, IPA, TPA, etc.) Knowledge of health insurance terminology.
  • Knowledge of health insurance benefits verification (medical, behavioral, etc.)
  • Knowledge of health insurance requirements and follow up procedures.
  • Knowledge of coordination of benefits requirements and processes.
  • Knowledge of health insurance patient billing requirements.
  • Knowledge of insurance rejection/denial processing to perform follow up activity.
  • Ability to type efficiently and accurately.
  • Strong analytical and problem solving skills.

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • Have good attendance.
  • Work at a desk, utilizing a computer.
  • Communicate by telephone.
  • Operate a PC and other office equipment (copier, fax, etc.).
  • Move freely between offices
  • The work environment corresponds to the average office environment.

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.