PPO Account Rep, Lead

Company: Brown & Toland Physicians
Location: Oakland
Posted on: May 11, 2022

Job Description:

Job DescriptionJob Title:PPO Account Representative, Lead FLSA Status:Non -Exempt Job Code:S3CS0111Pay Grade:CoreBay Area Date/Revision Date:1/01/2022Track:SupportFamily:Customer ServiceLevel:3Sub-Family:Customer Service Job Summary & ResponsibilitiesJob Summary The PPO Account Lead Rep role is responsible to provide a full range of revenue cycle management support to PPO contracted physicians and their practice offices. - In addition to the regular Account Rep Responsibilities, the Account Lead is responsible for oversite of the claim quality audits and SME for the team reps. - Account lead should accurately perform multiple tasks to meet the full cycle billing payments to our contracted provider. - These tasks include Epic Resolute Work Queue assignments, payment posting, correspondence and CRM review and resolution. - - The account Rep Lead is responsible to track all inquiries and appropriate follow-up are required.Works with B&T departments in the resolution of all customers inquires in a timely and professional manner. - Essential Functions

• EPIC Resolute Work queue assignments
• EPIC CRM research and resolution
• Imagenet Correspondence, Appeal & EOB inventory
• Coordinates with internal and external sources to obtain necessary information to resolve claims, escalates issues as appropriate to Lead, Supervisor or Manager.
• Provide education and assist in trouble shooting for Customer Service and other departments related to PPO Claim processing
• Adhere to established production and quality standards.
• Claim Quality Audit Review and reporting
• EPIC Upgrade testing and training for PPO Account Representative
• Informal leader for the PPO Account team Key Skills
  • Demonstrate ability all PPO Claims are resolved satisfactorily and within established Turnaround times.
  • Demonstrate ability all PPO Claim Audits are resolved satisfactorily and within established Turnaround times - -
  • Demonstrate ability to conveys confidence and expertise through the utilization of appropriate reference materials when resolving claims
  • Ability to research issues and follow up with providers or Customer Service within the established turnaround time measures and escalate complicated issues to appropriate team members
  • Demonstrate ability in oral and written communications, professional approach to problem resolution and organizational skills.
  • Demonstrated ability to work as an effective team member always recognizing the need for a positive way.Management
    • This is not a people management role QualificationsEducation
      • High school Diploma or G.E.D and equivalent of 5 years of relevant experience Preferred Education
        • Some college level coursework Experience
          • 5+ years of Revenue Cycle management in an IPA or Professional billing setting -
          • 5+ years of knowledge of Claim Clearing house management, i.e.Change Health
          • 5+ year of understanding and application of ICD-10, RVS, CPT codes, basic medical terminology.Preferred Experience
            • 7+ years of Revenue Cycle management in an IPA or Professional billing setting - - -
            • Working experience using Epic Resolute Practice Management System
            • 7 + year of understanding and application of ICD-10, RVS, CPT codes, basic medical terminology.Required Certifications
              • N/APreferred Certifications
                • N/ARole CompetenciesCompetencyLevelDescriptionCore CompetenciesCollaborationIndividual Contributor
                  • Works cooperatively with Team members across the organization to achieve shared objectives
                  • Partners with Team Members to get work done
                  • Gains trust and support across the organizationExcellenceIndividual Contributor
                    • Regularly meets targets and metrics
                    • Pushes Team Members to set high standards and performance targets and exceed them
                    • Sets solid targets that drive resultsCompassionIndividual Contributor
                      • Contributes to a work climate where differences are valued and supported
                      • Applies Team Members diverse experiences, styles, backgrounds and perspectives
                      • Treats Team Members with kindnessIntegrityIndividual Contributor
                        • Acts fairly despite conflicting demands
                        • Behaves in a way that is consistent with what he/she says around honesty, ethics, and integrity; leads by example
                        • Presents truthful information even if not always favorableInnovationIndividual Contributor
                          • Introduces new ways of looking at problems
                          • Can take a creative idea and put it into practice
                          • Encourages diverse thinking to promote and nurture innovationWork DimensionsLevel FactorRequirement (direct from leveling guide)Work DimensionScope & Impact--Knowledge & SkillUnderstands job and is resourceful and effectiveComplexityWorks on moderately complex tasks requiring judgement and initiativeInteraction--SupervisionWorks largely independentlyExperienceDoes not require advanced education, 5+ years professional experiencePhysical Requirements and Work Environment - The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
                            • Activity: Sit: Continuously (more than 2/3 of the work shift)
                            • Activity: Stand: Occasionally (up to 1/3 of the work shift)
                            • Activity: Walk: Occasionally (up to 1/3 of the work shift)
                            • Motion: Bend/Twist: Up to 1/3 of time
                            • Motion: Carry/Lift: Up to 1/3 of time
                            • Motion: Reach: Up to 1/3 of time
                            • Motion: Squat: Up to 1/3 of time
                            • Use of Hands (Left/Right): General Motor Function
                            • Use of Hands (Left/Right): Precise Motor Function (Or Fine Manipulation)
                            • Use of Hands: Repetitive Motion: 1/3 or more of time
                            • Weight Lifted/Force Exerted: Up to 10 lbs: Up to 1/3 of time
                            • Work Environment: Special visual or auditory requirements including working with a computer terminal.

Keywords: Brown & Toland Physicians, Oakland , PPO Account Rep, Lead, Other , Oakland, California