UW Medicine Faculty Practice Plan Services (FPPS) supports UW Physicians (UWP), a practice group for more than 3,000 physicians and other healthcare professionals associated with UW Medicine. UW Medicine includes Harborview Medical Center, UW Medical Center - Montlake, UW Primary Care Clinics, UW Medical Center - Northwest, the UW School of Medicine, Valley Medical Center, and Airlift Northwest. UWP members also practice at the Seattle Cancer Care Alliance, a partnership of UW Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children’s Hospital.

The Claims Team Lead is responsible for developing more efficient and effective workflows for claims review, and clearing of claim edits. They will identiy training opportunities, develop training materials (in conjunction with the UWP Trainers), and work directly with staff to ensure uniform application of all UW Medicine policies, procedures, and workflows. Additionally, they will perform Claims Specialist work in order to maintain queue volumes at a reasonable level, and in order to cover for scheduled absences and illnesses.

MINIMUM QUALIFICATIONS

High School graduation or equivalent AND three years of experience in patient accounting, customer service, or a related office environment

OR

Equivalent education/experience.


Knowledge, Skills & Abilities:

Ability to plan, organize, and effectively work with the supervisor to schedule workload and manage production backlogs in an efficient and proactive manner.

Ability to understand and analyze system connections and impacts, both internal and external, for a large healthcare organization.

Ability to utilize root/cause analysis to make process improvement recommendations to supervisor.

Knowledge of one-on-one instructional techniques.

Knowledge of Coordination of Benefit Rules and correct filing order among the various payers.

Use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.

Ability to complete detail-oriented work in a timely manner.

Ability to maintain confidentiality and handle sensitive information with solid judgment and discretion.

Ability to prioritize workload and meet quality and production standards.

Ability to read and understand written sentences and paragraphs in work related documents.

Ability to work well with a variety of people and be a team player.

Excellent oral and written communication skills, with the ability to convey a positive and professional image, and to interact effectively with diverse personalities and backgrounds.

Excellent typing/keyboarding skills with a high degree of accuracy to input data, process information and extract information in various report and presentation formats.

Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

Computer/Software:

Proficiency with Windows based software and Microsoft Office Suite products in a network environment.

Essential Duties and Responsibilities

Resolve pre-processing errors and edits from payers. This may involve correcting patient registration information, posting rejections, or forwarding the claim to a medical coding specialist for review, prior to claims submission to payers.

Identify coding issues and provide coding feedback to the Pro-fee Coders as appropriate.

Effectively plan, organize, and work with the supervisor to schedule workload and manage production backlogs in an efficient and proactive manner.

Complete testing as needed by Applications Management regarding system upgrade, workflow changes and edit modifications.

Assimilate and operationalize all quarterly/yearly updates to each payer’s billing rules, guidelines, exceptions, and carve-outs, making sure we’ve captured any changes that may require building additional charge edits or claim edits, submitting necessary forms for system updates.

Monitor Account Merge requests in Service Desk Manager for volume and elevated priority situations.

Monitor & complete Visit Filing work queues when new coverages are added to patient account by other areas, including reviewing for incorrect payments from insurance or patient, and rebill charges accordingly.

Gather and maintain a base knowledge in all specialty workflows assigned to team members to be able to cover for absences, implications on system enhancements and trainings.

Make recommendations for the creation of new claim edits, deletion of obsolete ones, and/or revisions to existing edits in order to improve efficiency.

Keep current with payer updates and applies knowledge to assist in the adjudication of claims.

Observe employees at work, provide feedback, and facilitate problem solving to enhance performance of team members:

o Address employee’s specific gaps in skill or experience through guidance and encouragement.
o Introduce new procedures or technologies.
o Help build strong workplace relationships and promotes a positive work environment through open and constructive communication.
o Motivate, encourage and challenge staff.
o Provide help and support when needed.
o Work collaboratively with the training department to develop effective desk level support training.
o Mentor and train staff to support achievement of quality assurance expectations.

Research and navigate a variety of sources to obtain/verify claim/eligibility information via payer websites and/or confer with payers by phone.

Answer questions regarding team functions.

Conduct written and oral communications with insurance follow up teams/third party payers/others to resolve claims issues.

Link coverage additions, deletions, corrections across all service areas in order to prevent future claim edits from firing.

Perform other duties, as assigned.