Department:            Provider Services

Reports To:             Manager/Supervisor, Provider Services Correspondence

Position Overview:

The Provider Services Correspondence Team Leader is responsible for assisting in the daily operation of the Correspondence department.  The Team Leader is responsible for assuring the accuracy and appropriateness of the various functions performed by the Provider Services Correspondence Department

Duties and Responsibilities: 

· Monitor written and telephone inquiries, to ensure responses are sent accurately and timely. 

· Monitor claims processed to ensure accuracy and compliance with plan guidelines.

 § Monitor correspondence activity and daily forecasting methodologies to meet departmental and client specific goals and objectives. 

§Monitor production of agents with regards to daily written correspondence activity, quality of service, and consistency of information. 

§Provide statistical analysis of the staff’s activity as well as provide executive level and quality assurance reports. 

§Support the department with strategic goals, implementation of new business and state/client audit reviews. 

§Resolve administrative problems and questions with members, providers, auditors and other internal/external departments for resolution of workflow issues. 

§Resolve administrative complaints and appeals to meet regulatory timeframes. 

§Prioritize and meet all regulatory and client reporting as well as respond to Department of Health (DOH) inquiries.

· Assist Claims Correspondence Analysts with elevated claims issues, as required. 

·Review adjustments and correspondence to ensure accuracy and provide feedback to the staff 

· Reduce DOI complaints through rapid response elevation process 

·Develop elevation process to insure rapid response to providers on highly sensitive inquiries 

·Keep management informed of issues adversely impacting service levels; suggest and / or implement corrective action. 

·Review quality statistics and trends; coordinate efforts with the Quality Assurance Department to implement necessary steps for improvement. 

·Perform workflow analysis to improve processes; identify trends and reasons on incoming telephone and written inquiry volume; recommend and / or implement the necessary steps for improvement. 

·Preview root cause of provider inquiries.  Collaborate with internal departments to implement change.

·Participate in special projects as required.

Qualifications: 

· High School diploma / GED required; college graduate preferred. 

·  Minimum of one (1) year experience processing UB92 and HCFA 1500 claims preferred.

· Ability to read and interpret related documents, such as medical reports, procedure manuals and complaint correspondence required 

·Proficiency in Microsoft applications (MS Word / Excel) required. 

·Excellent verbal, written and interpersonal communication skills required

Equal Opportunity Employer