Senior Lead Coordinator, Revenue Cycle

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Position Summary

As the Senior Lead Coordinator you will be responsible for implementing and maintaining comprehensive billing review processes. You will identify and quantify trends/issues and effectively communicate/report them to the appropriate members of the management team and payer business partners along with the potential impact.

You will assist leadership in building and maintaining a high performing highly engaged this role you will also provide excellent mentorship and support to your colleagues as well as design and implement training classes.

The key responsibilities of the Medical Revenue Cycle Senior Lead Coordinator are:

• Review and analyze patient profiles benefits and prior authorizations to identify potential issues affecting clean claims.
• Collaborate with clinical and administrative teams to ensure accurate documentation is maintained and available for claims processing.
• Monitor claims submissions and follow up on pending claims to expedite resolution and payment.
• Identify trends in claims denials and develop strategies for improvement.
• Conduct training sessions for staff on best practices for claims submissions and compliance.
• Maintain up-to-date knowledge of insurance policies regulations and healthcare trends that impact claims processing.
• Prepare reports on claims performance metrics and communicate findings to leadership.
• Act as a liaison between our organization and payers to resolve complex claims issues.
• Provide guidance and support to coordinators and staff members fostering a culture of teamwork and excellence.
• Ensure compliance with all regulatory requirements and organizational policies related to claims processing and patient data management.
• Analyzes current workflows to identify bottlenecks or inefficiencies and implements strategies to streamline processes reduce errors and enhance revenue cycle outcomes.
• Collaborates with stakeholders to implement new billing and coding technology develop standardized procedures and train staff on best practices.
• Coordinates with external stakeholders such as insurance companies vendors and patients to resolve and/or clarify billing and reimbursement issues.
• Coordinates the implementation of internal controls and billing procedures to ensure the integrity and accuracy of reconciliation activities.
• Join forces with Payers Payer Business Partners Sales Internal Department to secure needed documentation required to complete billing
• Ensure documentation aligns with the request and validate its accuracy and timely submission
• Performing detailed review and analysis of unbilled claims including but not limited to benefits and eligibility verification and prior authorization review prior to confirm accuracy prior to billing

Required Qualifications

• 2 years experience in medical benefit insurance verification
• 18 months of experience as a Medical Billing or Collections Specialist
• High level of proficiency with Excel.
• Excellent communication organizational problem solving and interpersonal skills.
• Extreme accuracy and attention to detail and data standards.
• Must live within a 1 hour commute to the Monroeville office.

Preferred Qualifications

• Ability to work in team and coordinate work efforts.
• Experience with A/R reporting including trending aging etc.
• Proficient in all Revenue Cycle systems
• Experience using One Note

Education

• Associates degree or equivalent work experience may substitute.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.