Recovery Team Lead
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Job Description
Repricing Team Lead analyzing healthcare claims and reimbursement data for CorVel’s cost-containment division, CERIS. Managing claims audit workflows, team performance, reimbursement analysis, reporting, and escalated client requests.
Responsibilities:
- Analyze and monitor claims audit data across multiple platforms
- Manage and prioritize staff daily work assignments for timely and accurate processing
- Conduct interdepartmental quality audits and claims processing
- Reduce response timeframes and mitigate inquiries or escalations through proactive problem-solving
- Set team standards and deadlines, measure results, and provide feedback
- Lead team performance and maintain morale through accountability and example
- Assist leadership with complex information from financial, clinical, and operational systems
- Assist with pricing claims according to provider contracts
- Support resolution of customer complaints, inquiries, and bill review disputes
- Identify and monitor account-detail and workflow barriers
- Make process improvements and initiate problem-resolution actions
- Analyze Revenue Cycle transactions and provide trend analysis
- Produce daily, monthly, and annual evaluative and statistical reports
- Evaluate client data integrity and support Product and Account Management teams
- Participate in panel interviews, new-hire documentation, associate orientation, and termination processes
- Lead assigned initiatives and coordinate task teams or forums
- Review case rates, per diems, discounts, charges, and costs per claim
- Handle escalated requests from clients and executive leadership
- Support research and development projects, process documentation, training, quality audits, and surge activity
- Maintain strict confidentiality of medical records, PHI, and PII
Requirements:
- 5+ years of relevant experience in a medical or insurance field with heavy involvement in bill review processing of claims
- 3+ years of previous supervisory, management, or project management experience is a plus
- 3+ years of relevant experience or equivalent combination of education and work experience
- High School Diploma or higher preferred
- Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable
- Detailed knowledge of pay reimbursement methodology
- Strong understanding of claims processing
- Strong understanding of ICD-10 coding
- Strong understanding of DRG Validation, if applicable
- Strong understanding of healthcare revenue cycle and claims reimbursement
- Proficiency with MS Office, including Word, PowerPoint, Excel, and Outlook
- Knowledge of Windows operating system and Internet
- Strong analytical and problem-solving skills
- Strong attention to detail
- Ability to work independently and use critical thinking
- Strong interpersonal skills and adaptive communication style
- Ability to think and work independently within a team environment
- Ability to maintain confidentiality of medical records, PHI, and PII
Benefits:
- Medical (HDHP) w/Pharmacy
- Dental
- Vision
- Long Term Disability
- Health Savings Account
- Flexible Spending Account Options
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- Paid time off
- Career advancement opportunities
- Supportive culture
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