Medical Claims Team Leader, Robert Half

Medical Claims Team Leader

Robert Half

Location:

United States, St. Louis

Category:

Health and Beauty

Contract Type:

Employment contract

Salary:

80000.00 USD / Year

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Job Description:

The Medical Claims Team Leader will supervise a team of 6 direct reports handling claims, focusing on denials and appeals processes, conducting ALJ hearings, and ensuring compliance with CMS regulations. The role involves managing DME, overseeing billing procedures, and developing KPIs for a new business line.

Job Responsibility:

Supervising the claims procedure, ensuring accuracy and efficiency in DME
Handling the denials and appeals process, ensuring all cases are appropriately addressed
Leading and developing a team, fostering a supportive and productive environment
Conducting Administrative Law Judge (ALJ) hearings on a regular basis
Utilizing various software and systems including Allscripts and Cerner Technologies
Ensuring compliance with the regulations of Centers for Medicare & Medicaid Services (CMS)
Overseeing the billing procedures, specifically related to Medicare Billing, Medicare Claim, Medicare Risk Adjustment, Medicare Supplements, and Medicare Advantage
Carrying out audits in the healthcare sector, with a focus on Medicare and Medicaid
Managing the usage and maintenance of Durable Medical Equipment (DME)
Developing and tracking key performance indicators (KPIs) to measure the success and efficiency of the new business line
Administering the claim process for the organization, ensuring the smooth operation of all related functions

Requirements:

Minimum of 5 years of experience in Medical Coding Auditing
Experience managing a small team
Proficiency in medical coding software for healthcare management
Experience with Armed Forces Health Longitudinal Technology Application (AHLTA)
Familiarity with Cerner Technologies
Strong auditing skills, particularly in the healthcare sector
Experience with billing functions in a healthcare setting
Ability to construct and interpret charts and graphs
Knowledge of claim administration processes
Understanding of the regulations of Centers for Medicare & Medicaid Services (CMS)
Experience with Medicare Billing, Medicare Claim, Medicare Risk Adjustment, Medicare Supplements, and Medicare Advantage
Familiarity with Health Care Audits for Medicare and Medicaid
Experience with DME or Durable Medical Equipment
Proficiency in KPI Reporting in a healthcare context

Nice to have:

Experience with ALJ hearings
Ability to build a solid team
Experience in creating KPIs

What we offer:

Medical, vision, dental, and life and disability insurance
Eligibility to enroll in company 401(k) plan

Additional Information:

Job Posted:

March 23, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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