Enrollment and Billing Team Lead - PacificSource : Job Details

Government Enrollment And Billing Team Lead

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Essential Responsibilities:

• Maintain broad knowledge of all job positions assigned to team lead and provide supervision, training, evaluation and leadership to assigned staff.
• Evaluate performance of team members. Analyze results of performance reports to determine staffing and training needs related to department goals. Provide feedback, including regular one-on-one meetings with direct reports. Conduct and submit performance evaluations on a timely basis.
• Have a thorough understanding and use of the eligibility and member billing operation systems (EAM and EMS). Maintain workload in these specialty areas.
• Provide and/ or oversee training and orientation of new hires. Develop programs to assure ongoing training and coaching to new and current membership staff.
• Understand all applicable CMS and HPMS regulations and have the ability to educate internal and external customers. Investigate and settle issues within contract guidelines as needed. Relay information for dispute resolution to appropriate departments and personnel.
• Understand all applicable OHA and OAR regulations and have the ability to educate internal and external customers.
• Ensure all direct reports understand processes from end-to-end and assist with gaps as needed.
• Assist with answering inquiries from members as well as conduct auditing of member accounts, verifying the validity of any past-due accounts and the delinquent letter process to Medicare members.
• Ensure that all member-billing issues are submitted to business partners/vendors.
• Coordinate business activities by maintaining collaborative partnerships with key departments.
• Serve on various interoffice committees. Document and report any pertinent communication back to the manager, team or other.
• Assist with hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees.
• Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
• Assist with process improvement and work with other departments to improve interdepartmental processes.
• Utilize lean methodologies for continuous improvement opportunities. Use visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
• Assist the manager with daily operations including the development, analysis and implementation of policies and procedures, training, reporting and recognition programs.
• Actively participate as a key team member while creating and supporting a high-quality work environment to encourage a high performance.
• Provide backup for any of the department tasks that may become backlogged, have compliance risks or have other reasons for being unworkable by staff.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Support and participate in continuous improvement initiatives.
• Maintain professional, service oriented relationships.
• Ability to judge severity of problems and the need to escalate to management or employ external services.
• Perform other duties as assigned.

Work Experience:

Minimum of four years administrative experience in the health care industry, including two years in enrollment and billing in insurance. Supervisory experience preferred.

Education, Certificates, Licenses:

Associates degree or equivalent combination of experience and education.

Knowledge:

Effective written and oral communication. Ability to read and communicate policy and contract language. Demonstrated time management, critical thinking and problem solving skills. Ability to understand and interpret Federal and State regulations. Advanced proficiency in Microsoft Office Applications. Excel skills should include formulas, sorts, filters, VLOOKUP, IF statements, etc. Requires the ability to clearly articulate problem statements, collect data and establish facts.

Competencies:

Building Trust

Building a Successful Team

Aligning Performance for Success

Building Customer Loyalty

Building Strategic Work Relationships

Continuous Improvement

Decision Making

Facilitating Change

Leveraging Diversity

Driving for Results

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills:

Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization

Our Values:

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements:

Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer:

This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.