Support Lead

JOB SUMMARY: The Lead is responsible for assisting the supervisor with day-to-day workflow of the Department. In addition, this job is responsible for the handling, research, and communication regarding complex and escalated claims inquiries stemming from clients, providers, and team members.

JOB ROLES AND RESPONSIBILITIES:

1. Assist Supervisor in daily operations and processes within the department.
2. Identify and notify the supervisor of potential escalated issues or system related concerns.
3. Assist in training new employees and remedial training for existing employees, including new or revised procedures.
4. Provide general support to the team members, serve as a resource and answer questions Serves as subject matter expert and as back-up within the team.
5. Coach and mentor staff while assisting with more challenging issues and cases.
6. Support the quality audit review and rebuttal process.
7. Ensure the maintenance of and compliance with department performance metrics for production, accuracy, and turnaround time.
8. Foster and maintain relationships with internal and external customers, including but not limited to the provider, client, member, or other internal customer.
9. Monitor compliance with all departmental policies, procedures, and workflows and collaborate with the training team, as necessary.
10. Review workflows and outputs to recommend appropriate workflow revisions and collaborate with other internal departments.
11. Lead and/or participate in various research projects for Sr. Management and Clients, as assigned.
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company's Core Competencies and values held within.
15. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
16. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.

JOB SCOPE: The incumbent impacts efficiency and effectiveness of departmental operations. This is an entry level leadership role that has the authority and responsibility to facilitate and communicate training, new processes, coaching, and mentoring. The incumbent works independently under minimal supervision but collaborates and communicates with the supervisor or manager on a daily basis. Specific to HR actions such as hiring, salary adjustments, position changes, termination and other disciplinary actions, the incumbent refers to the Supervisor or Manager.