Government HMO Lead
Patient Business Services - Modesto, CA

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Job Title: Team Lead – Government

Date: March, 2013

Reports To: Supervisor/Manager, Government

Location: Modesto, CA

Department: A/R Follow-up Government


The Government Team Lead conducts Medicare, Medicaid and MediCal billing follow-up activities on patient accounts. Provides recommendations to management to improve processes. Generates and/or utilizes productivity and other tracking reports. Oversees daily work production and delegates work assignments to staff. Serves as a resource to staff and backup to management.



Manage own time and work assignments effectively.

Seek advice/feedback in terms of priorities or issues when necessary.

Assign production work to department staff. Monitor activities of staff to assess schedule adherence, accuracy, quality, productivity, timeliness and compliance with job requirements, policies and procedures. Report updates to management.

Provide staff with direction per management’s instruction or in management’s absence.

Provide basic on-the-job training for staff and serve as a resource to address questions related to the policies, processes and procedures.

Provide feedback to management about an employee’s performance, work behavior or training needs.

Resolve basic conflicts that arise as a result of workflow or procedures and report to management. Report and refer all employee grievances to management to address.

Receive employee time-off, schedule change or over-time requests in the absence of the manager, but forward and defer to management.

Recommend to management the tools and resources needed in department.


Review QA audit findings. Provide feedback and guidance to team members when procedural errors are identified through the QA audit process.

Follow-up to ensure corrections and QA recommendations are implemented.

Serve as point-of-contact for complaints or complicated accounts. Assist in resolving issues with accounts that are challenging to Medicare/Medicaid representatives.

Work billing items referred by employees for supervisor review, (e.g., send to proper payor, follow-up with AMR Operations, process write offs or adjustments). Provide feedback to employee for training purposes.

Follow-up on refund request letters from Medicare. Determine reason, enter notes in the Accounts Receivable Billing System, submit appeals, and/or advise Cash Department to refund or transfer funds.

Research and respond to e-mails from the PBS Customer Service Department

following-up on patient inquiries, (e.g., claim denials, collections and rebilling of


Follow-up on requests for write downs. Review codes for validity prior to management review and authorization.

Work rejected claims, (e.g., correct invalid ICD-9 codes, edit dashes or commas in

billing information, follow-up on unmatched addresses).

Participate in meetings with payors, and internal or external contacts as needed.

Oversee special projects.

Participate in training to improve processes.

Download, generate and/or distribute reports to staff to focus on agings and collections, (e.g., “Accounts Receivable”, “Collection Agency”, “Medicare Transmission Acknowledgement”).

Create weekly KPI reports for management, Finance and GMs to update the shared

PBS folder that includes KPI for other PBS departments. Report includes claims

submitted, denials, claims on hold in Medicare. Run them through aging to confirm


Run productivity report. Receive and review daily productivity reports (e.g., mail, aging) from Representatives.

Obtain status of unpaid claims needing follow-up by responsible Representative.

Assign as special project if volume of unpaid claims is larger than normal.

Input data into tracking mechanisms.

Review aging for denials due to untimely filing.

Communicate with customers, facilities, AMR Operations and payors.

Perform account transfers/merges.

Assist management with review and approval of adjustments.

Obtain and communicate to management daily check-write status submitted by Medicare. Log check numbers, dates, claim amount and other data to help manage cash flow. Confirm receipt of checks from bank report.

Monitor business calls via a call activity tracking system.

Notify management of any updates, changes or issues identified with carriers or staff.

Adhere to policies and procedures.

Perform other duties as required.


Communicate a willingness to help others succeed.

Work in a spirit of teamwork and cooperation.

Convey a sense of competence and commitment.

Use initiative to learn new skills, enhance personal knowledge and improve communications.

Demonstrate an ability to communicate and work well with others (e.g., customers, facilities, AMR Operations, payors).

Maintain excellent working relationships and communication with staff and management.

Mentor peers and department staff to meet production and quality standards.

Share workspace and resources as necessary.


Medical transportation and billing processes.

Accounts Receivable Billing System.

Terminology on a Patient Care Report (PCR), Hospital Face Sheet, and/or a Computer Aided Dispatch (CAD) Sheet.

Medical terminology and insurance terminology.

Process of signature and paperwork compliance.

Medicare, Medicaid and MediCal insurance billing guidelines.

Payor-specific requirements for Government department.

Distinctions between ALS/BLS/SCT/Wheelchair levels of service.

ICD-9 coding/condition codes and procedure codes.

HIPAA requirements.


Proficient with the Accounts Receivable Billing System and internet tools, (e.g., internet mapping programs, eligibility websites, address search engines).

Communicate effectively, (both orally and in writing) in English.

Train in a manner that is clear, thorough, pertinent, accurate, and consistent and is optimal for learning.

Perform basic arithmetic calculations with efficiency and accuracy.

Calculate figures and amounts such as discounts, interest and percentages.

Handle emotional callers with sensitivity and provide calming and objective resolutions.

Proficient with Microsoft Word and Excel.

Read and comprehend health insurance explanation of benefits.


Pass new-hire and department-specific testing, (e.g., data entry test and department specific aptitude testing).

Demonstrate flexibility in shifting daily priorities.

Meet deadlines, working within tight time constraints.

Handle a large volume of work.

Handle Team Lead responsibilities and production related duties of staff.

Provide employees with feedback that is accurate, objective, timely, constructive and diplomatic.

Evaluate workload, prioritize and distribute work assignments to staff, based on business need.

Prepare and/or analyze data and figures on reports and other sources.

Meet or exceed and sustain established standards for productivity and quality.

Minimum Requirements:


High School diploma or GED required; Associates Degree or certificate of completion in medical billing and coding preferred. Two (2) years previous medical transportation or healthcare billing experience required. Knowledge of Medicare, Medicaid, MediCal, and/or private insurance billing guidelines required. Knowledge of the Accounts Receivable Billing System and related processes conducted within PBS required. Previous mentoring and/or supervisory experience preferred.

Physical Requirements:


Light lifting (paper files, office equipment)

Working Environment:


Mandatory and/or voluntary overtime. Work a flexible schedule, at odd hours and various shifts with short notice as assigned.


Office environment (cubicles, enclosed offices)

Equipment Used:


Paper shredding equipment, projection equipment, general collating equipment


Copy machine, scanners, fax machine


Personal computer, telephone

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