Medicare Claims Research Lead - Promotion Only
PAML 30 reviews - Washington

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Assists with the daily operations and overseeing all functions for the Medicare Team. Knowledgeable of how each position on the team is conducted in order to assist with coverage and back-up of employees. Assists in identifying potential performance issues where disciplinary action should be considered. Collaborates with Supervisor to determine action and takes immediate action when warranted. Conducts weekly Quality Assurance on accounts that staff have worked and provides value-based training to coach for improvement when not meeting team benchmarks. Motivates and coaches team to success.

  • Assists in training of new/existing employees.
  • Reviews accounts in Direct Data Entry (DDE) for resolution and assists in decreasing denials on claims for first time payment.
  • Directs and oversee workflow of staff to ensure timely completion of all tasks assigned to them.
  • Conducts self in a professional manner at all times.
  • Maintains and reports Quarterly Credit Balance reports for various entities along with reporting to PAML Leadership monthly outcomes.
  • Availability to assist staff and to help decrease backlog in their bill classes.
  • Assists with disciplinary actions for employees who are not meeting performance levels in the department.
  • Enforces all of PAML’s policies and procedures with team members.
  • Completes all daily journal entries that are turned in by staff and completes reports for Leadership on monthly totals for journals.
  • Assists Supervisor and Manager in maintaining yearly goals that are set forth for staff.
  • Assists Supervisor and Manager in other areas as duties are assigned.
  • Weekly and monthly review accounts for staff QA. Each staff member will have ten random accounts that are to be reviewed and scored on the established QA standards. Follow up to the staff will include the accounts, score for each account, and overall score for the previous week. This is to be completed no later than Tuesday of each week.
  • Create, monitor and coach for improvement on productivity benchmarks for the team.

    • Minimum of three years experience in Laboratory, Hospital or Physician billing, particularly with Medicare and Medicare Advantage claims.
    • Minimum three years CPT4 and HCPC experience. Knowledge and understanding of CCI edits and modifiers.
    • Successful track, record in working and resolving AR in all aging categories.
    • Exceptional communication skills, verbal and written.
    • Knowledge and experience with Microsoft products such as; Word, Excel and Outlook Mail.
    • Strong organizational skills and ability to adapt to continuous change in the Medicare arena and workplace.
    • Ability to problem-solve, performing root-cause analysis then taking appropriate action.
    • Successful track record in achieving goals. Motivates the Medicare team to ensure goals are achieved and holds each team member equally accountable. Maintains a positive, cooperative attitude towards all team members.
    • Ability to coordinate and work in a positive, collaborative manner with AR Billing Leadership and coworkers in all departments.
    • Utilizes sound, independent judgment and has a track record of utilizing exceptional reasoning skills.
    • Ability to train employees in all aspects of their position, especially during periods of change.
    • Experience with Medicare Direct Data Entry (DDE) to monitor claims and assists staff with working claims returned to providers (RTP).
    • Proven track record of effectively handling stress and continual

      Preferred education, skills or experience
      • Two years leadership experience.
      • Previous experience with the disciplinary process of team members

About this company
30 reviews
Pathology Associates Medical Laboratories (PAML) is heading for the high road as a leading independent laboratory services provider in the...