Revenue Cycle Representative I Team Lead

Description

AIM OF THE POSITION

The Revenue Cycle Representative I Team Lead is a working lead responsible for performing Revenue Cycle Representative I duties while providing day-to-day operational support, training assistance, and workflow guidance to the RCR I team.

The Team Lead will maintain a reduced alpha account assignment to allow sufficient capacity to support team members, assist with onboarding and training, answer day-to-day workflow questions, and support review criteria and process-improvement projects assigned by RCM leadership.

The Team Lead is not a people manager and does not replace the responsibilities or authority of the RCM Supervisor/Manager

POSITION WITHIN THE ORGANIZATION

1. Reports to Reimbursement Supervisor

2. Cooperates with all departments across the organization

3. Organizes activities with Managed Care, IT, Commercial, Sales, Customer Care and external vendors

4. Participates in:

– Department meetings

– Project meetings

– Working groups

– Project groups

Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES

Key Responsibilities

· Maintain a reduced alpha split of RCR II accounts and perform Level II account responsibilities. Serve as the first point of operational support for RCR I team members.

· Assist with onboarding and training of new RCR employees.

· Reinforce established RCM workflows, payer procedures, documentation standards, and productivity expectations.

· Assist team members with complex Level I account questions and determine when escalation to RCR II or the supervisor is appropriate.

· Monitor day-to-day workflow and identify issues that may affect productivity, quality, aging, or cash.

· Assist leadership with review criteria, account audits, payer reviews, and special projects.

· Support quality-control activities and identify recurring errors or training opportunities.

· Communicate trends, challenges, and recommendations to the RCM Supervisor/Manager.

· Provide coverage for operational needs when necessary.

· Maintain patient confidentiality and ensure HIPAA compliance.

· Perform all responsibilities of the RCR I role when performing assigned account work.

Lead Allocation

Recommended workload allocation:

· 75% — RCR I production/account responsibilities

· 25% — Team Lead responsibilities

The Team Lead’s alpha assignment should be smaller than a standard RCR I alpha split to protect capacity for leadership-support responsibilities.

Performance Measures

· Team Lead account productivity

· Cash and aging performance

· Quality/error rate

· Training/onboarding effectiveness

· Team support responsiveness

· Timeliness of assigned projects

· Accuracy of review criteria

· Documentation and compliance

Account Follow-Up & Resolution

· Manage assigned alpha split of non-paid and underpaid accounts.

· Perform timely follow-up on outstanding claims and account balances.

· Identify the reason for non-payment, underpayment, or delayed payment and take appropriate action.

· Review account history, claim status, payer responses, payment activity, and documentation to determine the appropriate next step.

· Contact insurance payers regarding claim status, payment, denials, missing information, and outstanding balances.

· Identify accounts requiring escalation to RCM Level II.

· Maintain accurate and complete account documentation and follow-up notes.

· Work assigned aging inventory according to departmental priorities, productivity expectations, and established follow-up protocols.

· Identify trends or recurring payer issues and communicate them to leadership.

Patient-Centric Communication

· Respond to incoming patient phone calls, faxes, and emails related to account balances, claims, insurance, payments, and billing questions.

· Explain account activity, insurance processing, patient responsibility, and payment requirements in a clear and professional manner.

· Provide excellent customer service while maintaining appropriate boundaries and organizational policies.

· Resolve patient concerns at the representative level whenever possible.

· Escalate complex patient or payer issues when additional expertise or authority is required.

· Maintain patient confidentiality and comply with HIPAA and organizational privacy requirements.

Alpha Split Partnership

· Work collaboratively with the assigned RCM Level II representative supporting the same alpha population.

· Refer appeals, medical record requests, complex denials, and payer escalations to the appropriate Level II representative.

· Provide Level II with complete and accurate account information needed for advanced resolution.

· Follow up on Level II actions when additional account activity is required.

Productivity & Quality

· Meet established productivity, aging, cash collection, quality, and account resolution expectations.

· Maintain accurate documentation and follow established RCM workflows and payer protocols.

· Demonstrate adherence to quality standards and error-rate expectations.

· Participate in department audits, quality reviews, and performance improvement initiatives.

· Identify opportunities to improve processes, reduce aging, and accelerate cash realization.

Other Responsibilities

· Participate in assigned RCM projects and process-improvement initiatives.

· Assist with departmental coverage during periods of increased volume or staffing needs.

· Perform other duties as assigned by RCM leadership.

KEY CONTACTS
Internal

o This position may interface with all departments within the company.

External

o External Vendors

EDUCATION AND EXPERIENCE REQUIREMENTS
Required Qualifications

· High school diploma or equivalent required.

· 2+ years of healthcare revenue cycle, medical billing, collections, patient financial services, or related experience preferred.

· Laboratory, healthcare, hospital, physician, ASC, or other medical billing experience preferred.

· Strong understanding of insurance claims and payer processes.

· Strong verbal and written communication skills.

· Strong customer service and problem-solving skills.

· Ability to work independently while functioning effectively as part of a team.

· Strong organizational skills and attention to detail.

· Proficiency with Microsoft Office and healthcare billing/RCM systems.

· Ability to protect confidential patient and business information.

Core Competencies

· Patient-Centric Service

· Revenue Cycle Knowledge

· Account Resolution

· Payer Communication

· Customer Service

· Attention to Detail

· Accountability

· Productivity

· Problem Solving

· Teamwork

· Adaptability

· HIPAA Compliance

Performance Measures

Performance will be evaluated based on established departmental RCM metrics, which may include:

· Cash collections

· Aging inventory reduction

· Account follow-up timeliness

· Productivity

· Account resolution rate

· Quality/error rate

· Patient/customer service

· Documentation accuracy

· Attendance and reliability

· Compliance with RCM policies and procedures

KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)
Specific Knowledge Required:

Knowledge: Comprehension of a body of information acquired by experience or study.

Skill: A present, observable competence to perform a learned activity.

Ability: Competence to perform observable behavior.

• Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)

• Must be able to work in a fast-paced environment

• Must have strong organizational skills and attention to detail

• High degree of accuracy

• Manage multiple tasks independently

• Other skills necessary are accounting, data entry, general math, analytical, thoroughness, research, verbal/written communication

BEHAVIOURAL COMPETENCIES/DESIRED SKILLS

• Excellent problem resolution

• Excellent customer service skills

• Outside-the-box thinker

WORKING ENVIRONMENT

Establishes ADA (Americans with Disabilities Act) requirements

ENVIRONMENT/SAFETY/WORK CONDITIONS

Working conditions (inside or outside the office).

• This is an in-office position and is not remote

• General office environment. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Maintains a clean, neat, and orderly work area.

• Adheres to Department Specific Safety Guidelines.

• Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.

TRAVEL
· No travel is required

OTHER DUTIES

Other duties as required by management.