Quality Claims Team Lead

HealthSpring is committed to providing quality healthcare for our members, as well as forming strong relationships with our providers and their staff. HealthSpring takes an active role in building and maintaining the relationship between the health plan and the doctor by providing ongoing physician and office staff education.

 

Our Houston office is seeking a Quality Claims Team Lead for our Quality Claims Department. In this key position you will be responsible for providing daily supervision of QA staff and activities to promote the efficient operations of the QA department. As well as providing the professional and technical resources for the QA department to enable the Claims Department to meet the requirements of the health plans and IPA’s.

 

To meet the challenges of this position you must possess a minimum of 5-10 years industry experience in processing, training, documentation and quality review. Have previous supervisory experience; be highly motivated and results oriented with effective written and interpersonal skills, an effective communicator coupled with effective time management skills. Have working knowledge of medical terminology, ICD-9, CPT coding and auditing standards.

The responsibilities and functions of this position are to:

 Provide the professional and technical resource for QA and examiners to assist in processing issues.Provide one-on-one guidance to QA staff and examiners to achieve quality standards.Provide assistance in educating examiners individually with identified quality problems.Provide timely resolutions for Customer Service referrals, health plan and management related requests.Assist in supporting the training, documentation and quality assurance goals to increase examiner productivity and accuracy.Assist in the evaluation of departmental processes to promote increased accuracy and efficiencies by the development of new procedures.Review audit rebuttals for resolution with examinersOther duties as assigned by Manager. 

At Texas HealthSpring you’ll enjoy a professional yet casual working environment. We recognize that our most valuable asset is our people and the bottom line to our company success is our employees. You will find the pace here fast, fun and exhilarating. In our organization you have the opportunity to “Be the Best at Making People Better” Texas HealthSpring offers a competitive salary and a full range of benefits. HealthSpring is an EEO/AA employer. For immediate consideration, please email your resume along with salary requirements.