Job Description

Summary

 

The Provider Services Team Lead role is responsible for monitoring and supervising the Leon Health Provider Services call center queue and staff. This role will also be responsible for ensuring the Provider Services unit consistently meets and exceeds key performance indicators, such as call service level, abandonment rate, average speed of answer, individual average handle time, and schedule adherence. Furthermore, the role is responsible for ensuring the team meets and exceeds call quality standards through the development of tools, reference guides, and training and through the facilitation of coaching and training. This position reports to the Call Center Manager role.

 

Essential Duties and Responsibilities

 

- Conduct review of call recordings and call documentation and coach staff accordingly

- Coach staff on missed opportunities identified through reporting, auditing, and monitoring

- Conduct staff huddles every other day to discuss recent developments, trends, opportunities, and to refresh staff on department policy and procedures

- Act as a conduit between Provider Services staff and other areas, communicating trends, ideas, and prospective solutions

- Maintain continuous communication with leadership to ensure sufficient resources are allocated to meet volume and performance standards

- Identify and implement improvement opportunities to increase overall productivity and quality of service

- Generate and provide daily, weekly, monthly, and ad-hoc reporting

- Works with the Call Center Quality Analyst and Call Center Manager to identify opportunities for the creation of new training, quick reference guides, and other tools for use by call center staff

- Assists with the creation of new training, quick reference guides, and other tools for use by call center staff

- Facilitates both scheduled and ad-hoc instructor led trainings and tracks and coordinates e-learning training

- Address and resolve escalated issues originating from both external and internal customers

- Handle intake of calls originating from Provider Services and Member Services queues when necessitated by call volume

- Handle escalated calls from providers and members as necessary

- Monitor claims reprocessing and check tracer, check stop, and check reissue work queues to ensure all provider requests are resolved within applicable timeframes

- Monitor staff adherence to schedules and address non-compliance with staff as needed

- Monitor inbound Provider Services and Member Services queues throughout the day to ensure production standards and call center metrics are met and exceeded

- Monitor Provider Services e-mail and fax mailboxes, distribute communications to Provider Services staff for resolution and response, and ensure all communications are addressed within applicable timeframes

- Monitor outbound call campaigns to ensure staff are consistently meeting and exceeding production standards

- Collaborate with staff from other departments to identify opportunities for performance and process improvement and to facilitate provider requests pertaining to claims and payment processing, medical review, appeals review, and provider maintenance

- Coordinate, supervise and hold yourself accountable for the daily activities of Provider Services representatives

 

Required qualifications

1+ year leading and/or working in a call center

1+ year of Medicare experience

1+ year experience working in a provider services role or with a provider office

1+ year experience with medical billing and/or coding

Ability to work in an office setting

Microsoft Office proficiency

Bilingual in Spanish and English

Well-developed conflict management skills

Ability to pull, analyze, and evaluate data

Ability to effectively work with individuals originating from other departments and organizations to accomplish department objectives

 

Preferred Qualifications

 

2+ years Medicare experience

2+ years leading and/or working in a call center

2+ year experience with medical billing and/or coding

Knowledge of Medicare and state regulations and guidelines pertaining to provider claims submission and appeals

 

EDUCATION

 

Associate’s Degree or 2 years of relevant experience

Health services focused education/certification a plus

Language skills

Fluent in reading English

Spanish fluency a plus

Certificates, Licenses, Registrations

Medical billing and/or medical coding certification a plus.

 

Physical Demands/Work Environment

Work schedule is approximate and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays. Position requires the ability to work extended hours when necessary.

The physical demands and work environment characteristics described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This work requires the following physical activities: climbing, bending, stooping, kneeling, twisting, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors.