The Repricing Team Lead is responsible for analysis and monitoring of claims audit data across multiple platforms. The Team Lead manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and claims processing. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers.

This is a remote position.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Manage team performance by setting and communicating standards and deadlines, measuring results, and providing feedback. Maintain positive morale by leading the team through example and accountability with a focus on helping each member achieve their best performance.
• Assists leadership in obtaining complex information from various financial, clinical and operational systems and data sources.
• Ability to assist with pricing of claims according to provider contracts.
• Ability to assist team with problem solving regarding customer complaints, or inquiries, including bill review disputes verbally and in written communication.
• Identifies, quantifies and monitors account detail or workflow processes for barriers. Makes process improvements or initiates courses of action for problem resolution.
• Analyzes all forms of Revenue Cycle transactions and provides trend analysis.
• Produces daily, monthly and annual evaluative and statistical reports, analyzing drivers of variances from period to period in order to ensure the integrity and accuracy of revenue cycle data.
• Evaluates integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances.
• Participates in the panel interviews, prepares new hire documentation, facilitates associate orientation, and participates in the termination process (i.e., documents performance issues, recommends disciplinary actions).
• Independently leads initiatives as assigned by management, coordinating task teams or other forums to deliver results as identified and/or determined by leadership. Provides formal updates and closure.
• Ability to review and understand case rates, per diems, percentage of discounts, and provide detailed charges and costs per claim.
• Handles escalated requests from client and/or executive leadership.
• Assists with other research and development projects as directed by the manager. Projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), and/or any other project as determined by management.
• Ensure strict confidentiality of all medical records, PHI, and PII.
• Additional duties as assigned.

KNOWLEDGE & SKILLS:

• Ability to work independently and use critical thinking.
• Detailed knowledge of pay reimbursement methodology for
• Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
• Strong understanding of healthcare revenue cycle and claims reimbursement
• MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
• Strong analytical and problem-solving skills.
• Strong attention to detail and ability to deliver results in a fast paced and dynamic environment.
• Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovative
• Ability to think and work independently, while working in an overall team environment

EDUCATION/EXPERIENCE:

• 5 years of relevant experience in a medical or insurance field, which required heavy involvement in bill review processing of claims.
• 3 years of previous supervisory/management or project management experience a plus.
• 3 years of relevant experience or equivalent combination of educations and work experience.
• High School Diploma or higher preferred
• Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $14.90 - $22.74 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes 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, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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