Team Lead, RCM Operations

Key Responsibilities

• Act as the primary subject matter expert for assigned client accounts, with expert-level familiarity of client workflows, payer-specific challenges, and account nuances.
• Conduct thorough root cause analysis of first-pass rejected claims, denied claims, and discrepancies in reporting tools and clearinghouse submissions.
• Proactively identify accounts receivable (AR) and billing trends, payment anomalies, and potential issues before they escalate.
• Serve as the first line of escalation for team members encountering barriers in resolving accounts or workflow issues.
• Assign weekly workloads to team members based on claim volume, account needs, and strategic priorities.
• Use reporting tools, dashboards, and submission logs to validate completion and accuracy of assigned work.
• Proactively flag red flags in performance metrics or account behavior and take ownership of resolution or follow-up.
• Ensure all end-of-month processes are completed accurately and ready for reporting to clients.
• Support of functional role including but not limited to Accounts Receivable, Billing and Payment Posting.
• Facilitate onboarding and training of new hires across multiple software platforms and web-based systems.
• Provide hands-on support to team members in claim preparation, submission, and AR follow-up.
• Cultivate a culture of accountability, continuous improvement, and high performance through regular 1:1s, team syncs, and development check-ins.
• Generate and submit monthly reports on patient balances due and refund balances to CRCs.
• Leverage AR Aging Reports, Denial/Rejection Dashboards, EOB Tracking Logs, Claim Submission Logs, and Productivity Reports to guide oversight.
• Research and recommend adjustments/write-offs with supporting analysis for leadership approval.
• Perform other duties or projects as assigned by leadership.

Minimum Requirements

• A minimum of 2 years of hands-on experience with a proven track record in effectively managing the day-to-day functions of a billing and collections team, including reviewing, coding, and collecting professional services provided.
• Demonstrated proficiency in navigating the complexities of revenue cycle management within the healthcare industry is essential.
• A proactive change agent capable of driving organizational transformation and guiding teams through change management initiatives to propel the organization towards future success.
• Possesses strong leadership qualities and strategic vision to implement innovative solutions and adapt to evolving industry trends and regulations.
• Exceptional supervisory competencies, including demonstrated proficiency in leadership and team development, coaching, mentoring, and situational assessment skills.
• Proven track record of fostering a culture of continuous improvement and building high-performing teams that deliver exceptional results.
• Proficient in utilizing a variety of software applications essential for revenue cycle management, including Google for Business, Microsoft Excel, Word, and other relevant tools and platforms.
• Familiarity with clearinghouses and other Software as a Service (SaaS) products used in the healthcare billing and collections process is highly desirable.

HIPAA Requirements

All associates are required to comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations regarding the protection of patient health information. This includes adherence to the organization's Notice of Privacy Practices and HIPAA Privacy Policies and Procedures.