Program Support Medical Claims Processing Team Lead - (Remote)

At IQVIA, we look for the very best people, and then give them meaningful work to do. We don’t simply think about careers, we think about contributions.

Those who choose to work with us are joining a recognized global leader — a company uniquely positioned to help clients make the most of market opportunities and respond to challenges that affect global healthcare. We’re committed to blending industry expertise and advanced technology to deliver the most accurate perspectives and in-depth analytics on healthcare dynamics.

To join IQVIA means you’ll be part of a worldwide organization where one person can make a difference, and where collaboration and innovation rule. Our people are creative and client-focused. They are among the best and brightest in the industry. And they bring a broad range of expertise to the table. Our people are analysts, statisticians, software engineers, consultants, sales leaders, marketing and product managers, and more. The key to our success is our people, whose experience, talent, commitment and diversity set the standard for the health information industry.

Our solutions offer a strategic approach to generating and presenting the information for these initiatives, including:

• A powerful analytic engine for running a wide range of clinical quality and cost measures to generate the information presented by our applications.
• Intuitive user interfaces for presenting the information to effectively engage physicians and members and to influence behavior at the point of choice.
• A common core technology platform that is easy to add onto, supporting the evolution of your transparency and performance management.

Role Purpose:

• A Medical Claims Processing Team Lead is expected to be an expert in reading and interpreting EOBs, experience with CMS1500 forms and extensive experience with Procedure codes. The candidate must have a comprehensive understanding of our operational processes and business objectives. The person must thrive in a team environment and possess the ability to coach and mentor individuals while also maintaining the primary function of customer support. A Team Leader is expected to run reports, act as the escalation point when Program Support Representatives (PSR) need assistance and help to ensure the quality of customer interactions. The capacity to understand and continue to enhance program support knowledge, communication skills and professionalism are essential to gain the respect and support of team members.

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Principal Accountabilities:

• Answer incoming calls and/or Process medical claims when required, troubleshoot, resolve issues and provide timely resolutions for clients, HCP offices and patients.
• Gain knowledge necessary to become the SME on various programs
• Act as a point of escalation for Medical Billers regarding policy, procedures and customer interactions requiring Supervisor intervention
• Train, coach, and mentor Medical Billers. Lead by example to achieve team and overall department goals
• Help to define/enforce best practices and support management driven initiatives
• Provide reports, analysis and offer recommendations for how to improve the customer and HCP facility experience or drive operational efficiencies
• Complete ad-hoc project work as defined by Supervisor
• Proactively identify training opportunities and provide recommended solutions to enhance the overall interaction of the HCP facility experience
• Ability to backup Supervisor activities when required
• Flexibility in scheduling when requested

 

Minimum Education & Experience:

• HIPPA certified
• Experience in claim processing required
• We require candidates to have a minimum Medical Billing background of 3 + years.
• Medical Billing and Coding Certification required
• Ability to interpret Explanation of Benefits (EOB)
• SME in PAAS Program Support operations
• Customer Service Experience preferred.
• Pharmacy Technician experience preferred.

 

IQVIA is an Equal Opportunity Employer. We cultivate a diverse corporate culture across the 100+ countries where we operate, celebrating and rewarding teamwork and inclusiveness. By embracing our differences, we create innovative solutions that are good for IQVIA, our clients, and the advancement of healthcare everywhere.

 

#LI-DNP

 

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

 

We are committed to providing equal employment opportunities for all, including veterans and candidates with disabilities. https://jobs.iqvia.com/eoe

 

IQVIA’s ability to operate and provide certain services to customers and partners necessitates IQVIA and its employees meet specific requirements regarding COVID-19 vaccination status. https://jobs.iqvia.com/covid-19-vaccine-status

 

The potential base pay range for this role is $24-$25/hr per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.