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Medical Claims Team Lead
This is an exciting opportunity to join a rapidly growing company!
PRIA Healthcare works with the most progressive companies in the MedTech industry, we build comprehensive patient access solutions that accelerate the commercialization and rapid adoption of truly innovative procedures. We are currently looking for a Medical Claims Team Lead that is ready to join our team of skilled and dedicated individuals supporting the mission of patient access to care and customer service.
In this role, you will be supporting a team of Case Managers that support our Patient Access programs. Our Patient Access Programs are designed to be dedicated to a specific Medical Device Manufacturer with a new and innovative medical device, considered to be Experimental/Investigational and provide day to day support of Prior Authorizations and Appeals for those specific Category 3 CPT codes. Our goal is to drive product/program utilization by submitting patient-based appeals of denied authorizations. By driving utilization and demonstrating demand we are working to create positive insurance coverage for the new product. Experience working with insurance authorizations and appeals and knowledge of medical reimbursement policies within a healthcare organization are required.
In addition to a well-rounded benefits package, Paid Time Off, Medical/Dental/Vision and 401(k), we also offer our employees training opportunities including tuition reimbursement, career development courses and employee referral programs.
But wait, there’s more… culture is what unites us. We are proud of the environment we have built that defines our culture and focuses on keeping our employees engaged, healthy, happy and motivated. We have committees that meet regularly to develop creative ideas to plan fun activities, volunteer work days and to promote wellness.
PRIA Healthcare was recognized as one of the Best Places to Work in Connecticut in 2020!
- Possess strong organizational, administrative, leadership and interpersonal skills; must be able to work independently and in a team environment with a wide variety of people
- Supervise a team and provide leadership
- Provide training, guidance and direction to team as needed
- Work in conjunction with Account Manager to be main point of contact for clients; weekly program reviews, calls, frequent questions or concerns regarding the program
- Run reports and manage case distribution amongst team
- Review caseloads on a daily/weekly/monthly basis and perform case audits on an as-need basis
- Report data and audit results into findings report and share with management
- Understands, supports, and improves all Standard Operating Procedures for assigned program
- Participates in Program Supervisor meetings; create supervisory, management reports for meeting as needed
- Works closely with other Supervisors to improve operations practices
- Case management and processing utilizing Salesforce.com platform
- Provide oversight at all levels of an insurance appeal
- Utilize appropriate resources to gather supporting documentation (i.e. state protocols, physician/hospital medical records, state or federal statutes, patient/physician letters, etc.)
- Provides exceptional service to clients, patients and providers
- Interact closely with payer appeals and utilization departments
- Researches payer statutes, regulations, and regional requirements
- Comply with company HIPAA laws and other policies and procedures
- Experience managing multiple people
- Hiring, interviewing and training skills are a must
- Ability to create a positive and fun team environment
- Must be proficient in Microsoft Office
- Must demonstrate excellent communication skills, verbal and written
- Experience working with insurance claims, appeals, prior authorization and billing/coding
- College degree preferred but will substitute for applicable work experience
- Experience with Medicare, Medicaid, Tricare, Workers Compensation and Commercial Insurance
PRIA Healthcare Management offers a competitive package of benefits including but not limited to Medical/Dental Insurance, 401K, Access to Long Term and Short-Term Disability, Paid Time Off and Paid Holidays.
This position will work out of our West Hartford office location, 71 Raymond Road, West Hartford (SPACES) in Blue Back Square.