Claims Specialist Lead

Kansas Health System; Lenexa (KS); On-site; USD 75,000 - 110,000; Full time

Job summary

Kansas Health System seeks a Claims Specialist Lead to support the Claims Manager and staff with claim issues. This role entails workload assignments, mentoring, and ensuring adherence to government and managed care regulations.

Ideal candidates have 3+ years in claims processing, a high school diploma or GED, and preferably an Associate degree. Epic experience is preferred to optimize workflow and accuracy.

Qualifications

• 3+ years of experience in claims or insurance processing.
• Epic experience is preferred but not required.
• Strong communication and problem-solving skills.

Responsibilities

• Coordinates the team’s workload and assignments.
• Mentors team members and supports training.
• Serves as SME in absence of department manager for internal/external customers.
• Identifies trends in claims processing with payers and clears house.
• Confirms receipt of daily billing files and researches claim rejections.
• Documents and communicates rejection trends or delays to management.
• Performs paper claim submission and supporting documentation as required.

Skills

Claims processing

Team workload coordination

Mentoring

Problem solving

Education

High School Diploma or GED

Associate degree

Tools

Epic experience

Job description

Position Title

Claims Specialist Lead

Days

Full Time

Location

Southlake Campus

Position Summary / Career Interest

The Claims Specialist Lead is responsible for assisting the Claims Manager and Claims Staff with claim issues. The positions assist the Claims Manager with workload assignments as needed, filling in for staff as needed, and troubleshooting questions in the absence of the Claims Manager. Complies with governmental and managed care rules and regulations. Meets department goals as well as productivity and quality standards.

Responsibilities and Essential Job Functions

• Assists in coordinating the team's workload.
• Works closely with team members on problem solving, training and mentoring.
• Acts as subject matter expert in absence of the department manager to both internal and external customers.
• Observes and communicates to the Claims manager trends with claims processing by insurance companies or technical issues with the claims clearing house.
• Confirms receipt of daily billing files by the claims clearing house.
• Researches and resolves any claim rejections within designated timeframes.
• Reports any claim rejection trends or delays to management.
• Submits paper claims and supporting documentation as required by payers.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• High School Graduate or GED.
• 3 or more years of experience in claims, or insurance processing.

Preferred Education and Experience

• Associates Degree in a related field of study from an accredited college or university.
• 4 or more years of Epic experience.

Time Type

Full time

Job Requisition ID

R-58518

NOTE

The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status. See also Diversity, Equity & Inclusion.

The health system provides reasonable accommodations to qualified individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link [e-mail].

Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.

Additional Resources

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