Encounter Team Lead (Full Time, Remote, North Carolina Based)

The Encounter Team Lead provides training/development, consultation, and direction to Encounter Analysts and collaborates with Encounter Manager and other departments to improve Encounter processes and Claims system changes. The Encounter Team Lead also facilitates peer reviews and independent AR audits to identify areas for improvement and correction. The position provides guidance and training/technical assistance to delegated vendors to strengthen the performance of Alliance Health Encounter Service Level Agreements. This position creates reporting tools to aid in identification of areas needing attention and to communicate performance.

This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, the selected candidate will be required to come into the Alliance Office for business and team meetings as needed.

Responsibilities & Duties

Provide Guidance and Consultation to Encounter Analysts

Assist the Encounter Analysts in reviewing claim errors

Provide daily consultation to Encounter Analysts to resolve processing issues

Facilitate monthly peer reviews

Ensure staff is taking the appropriate steps even when it may require escalation for resolution

Role model professional communication and conduct at all times

Provide Training and Development to Encounter Analysts

• Provide claims/encounters processing training for new and existing staff
• Onboard and train new staff members
• Provide ongoing in-person and virtual learning opportunities to include 1:1 training, shadowing, provision of routine feedback
• Assist in creation of desk procedures

Analyze Data and Make Recommendations

• Review and analyze daily, weekly and monthly reports to help track progress and recommend procedure and process changes to increase productivity 
• Review Encounter production and quality levels for performance and monitor Provider feedback. Communicate areas of staff performance concerns to Encounter Manager
• Monitor and record performance measures and compile associated reports

Improve Quality of Encounter Processing Procedures and Performance

• Develop and implement approved and updated procedures and desk references to improve quality and performance
• Stay abreast of related regulatory, compliance and departmental updates to meet departmental metric requirements
• Collaborate with IT, Enrollment, Provider Network, and Claim teams to assist with successful encounter submissions
• Maintain a working knowledge of cross departmental functions to appropriately advise on encounter-related issues
• Provide backup coverage to supervisory staff as needed

 Support Expansion and New Business

• Learn new skills related to expansion and new business requirements per Alliance Health & Vendor contracts. This includes, but is not limited to: coverage of additional catchment areas, new covered services, processing and handling of physical health claims

Education & Experience

High school diploma or equivalent and five (5) or more years of experience processing behavioral or physical health claims and analyzing claims processing data

Preferred:

• Experience with Medicaid and State claims processing and/or claims denial management
• Experience with Medicaid and State Encounter data
• Experience leading a team and conducting trainings and presentations
• Knowledge, Skills, & Abilities
• Training/Presentation
• Organization
• Knowledge of Electronic Data Interchange (EDI) files
• Knowledge of Medicaid Claims processing
• Working knowledge of AR system
• Customer Service; Interpersonal Relationships
• Good written and oral communication skills
• Research, statistical analysis and reporting skills
• Complex Problem Solving
• Ability to communicate technical concepts to lay persons
• Ability to make prompt decisions on complex matters and make evaluations concerning day to day operations
• Ability to prepare concise and accurate reports and plans

Salary Range

$25.75 - $34.12/ Hourly

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity

 An excellent fringe benefit package accompanies the salary, which includes:  

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility