HB Billing and Follow-Up – Team Lead is responsible for the accurate and timely submissions of facility claims to the third-party payors. In addition to claim submission, responsibilities include timely corrections of all assigned claim rejection and claim denial categories. The HB Billing and Follow-Up – Team Lead contacts third party payers appropriately if there is no response after claim submission. The HB Billing and Follow-Up – Team Lead ensures proper adjudication of all payable charges by the third party payor, bringing the insurance liability to a zero balance. This position supports leadership staff in identifying and mitigating payment delays. The HB Billing and Follow-Up – Team Lead takes on a limited management role in the distribution daily assignments and priorities for the team and provides direct elbow support to the HB Billing and Follow-Up Specialist I’s & II in resolving complex barriers.
- Keep ProMedica’s mission, “To improve your health and well-being”, as the foundation of employment.
- Demonstrate personally and foster a work environment that includes ProMedica Values; Compassion, Innovation, Teamwork, and Excellence.
- Using various Patient Account Management and Bill Scrubbing software applications, such as Epic and Quadax, perform a variety of hospital billing and claim follow up activities to achieve maximum reimbursement for all billable services provided by the facility from the appropriate third party payor.
- Contact patients for necessary information pertaining to registration, billing and collection.
- Answer all written correspondence and phone inquiries from insurance companies, internal or external departments, local, state or federal agencies and/or patients/guarantors in a timely manner with professionalism and exceptional customer service.
- Ensure personal and team member understanding of department billing and follow-up procedures and workflows, including system functionality and program logic as it applies to assistance in procedures and workflows.
- Maintain elevated attention to detail by reviewing all work for completeness and accuracy in compliance with system quality assurance policies. Complete billing and follow-up tasks meeting department QA standards as demonstrated on the monthly Key Performance Indicators (KPI).
- Function as a team member to organize and prioritize responsibilities to complete daily work requirements:
- Comply with changes in duties and assignments in a positive and cooperative manner.
- Adjust to peaks in workload.
- Demonstrate flexibility and adaptability to change.
- Complete assignments in appropriate time frames.
- Aid co-workers to ensure completion of all assigned duties, as necessary.
- Work in collaboration with team to ensure prioritized daily tasks are completed when team members are absent, both planned and unplanned.
- Perform duties in a self-directed manner with minimal supervision or direction.
- Assign work based on identified workplans.
- Take ownership of identified issues, including internal and external customer service issues. Ensure the matter is resolved in a timely manner if able or escalate as appropriate with continued follow-up until resolution.
- Assist in identifying opportunities for improvement based on subject matter expertise, including generating automation ideas.
- Accountable for meeting individual and team designated KPI goals and deadlines.
- Complete assigned special projects in a timely and efficient manner.
- Strive for continuous improvement, including automation, in daily, weekly, monthly, and ad hoc assignments. Model and coach continuous improvement focus for team members.
- Keep abreast of in scope third party payor(s)’s billing, reimbursement and medical policies. Review in scope payer’s provider communication distributions, including registering for payer’s ListServe, for relevant updates and notifications. Work with leadership on any billing and follow-up procedure modifications needed as identified from payor updates.
- Keep fluent with in scope payer’s provider billing manual.
- Attend mandatory team and departmental meetings both on-site and virtual.
- Complete all assigned continuing education courses. i.e. HBI, Healthstream.
- Maintain current knowledge of Microsoft Office Application Suite. Self-assign training courses as needed. Including but not limited to Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft Teams and Microsoft OneNote.
- Acts as a knowledge resource for HB Billing and Follow-Up Specialist I’s and II’s
- Mentor and role-model for the team(s). Develop team members through orientation, group and one-on-one training and in-service.
- Collaborate with other team leads and team members to execute on department initiatives.
- Assist leadership in identifying department related agenda items for payor Joint Operating Committee (JOC) calls.
- Collect and report data related to KPI’s and functional goals.
- Serve as a communication liaison between leaders and teams on essential information.
- Accept all other duties as assigned.
Job Requirements:
Education: High School Diploma; OR Equivalent. Preferred: College Degree
Certification: Preferred: Certificate in billing and/or coding from an accredited school.
Years of Experience: Must have worked 2 years within ProMedica Hospital Billing; AND consistently met or exceeded all KPI expectations for promotion consideration to HB Billing and Follow-Up- Team Lead; OR related experience.
Skills: Must demonstrate the ability to accurately and independently solve problems by taking a basic skills test and scoring a minimum of 80%.
Salary Range: $31,200 - $68,536
We offer a competitive benefits package with coverage effective day one of employment which includes medical, dental, vision, company paid life insurance, paid time off, a 401k retirement plan, an employee assistance program and other voluntary coverage options and employee discounts.
The above list of accountabilities is intended to describe the general nature and level of work performed by the incumbent; it should not be considered exhaustive.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [email protected]
