Team Lead, Encounter Reimbursement

tango; Phoenix (AZ); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare reimbursement is seeking a Team Lead to oversee the Encounter Reimbursement team. This role requires expertise in Medicare/Medicaid managed care and involves mentoring staff, managing data encounters, and ensuring compliance with regulations. The position is full-time and remote, offering a competitive salary and opportunities for professional growth.

Qualifications

• 3-5 years’ experience in Medicare/Medicaid managed care, encounter data processing, healthcare analytics, or data quality assurance.
• Knowledge of CMS encounter data standards, 837 file formats, EDI transactions, ICD, CPT, HCPCS coding.

Responsibilities

• Main point of contact for Claim Encounters/Reimbursement team.
• Oversee processing of data encounters, fee schedules, and reimbursement methodologies per policies.
• Track and analyze encounter results, providing solutions and enhancements.

Skills

Analytical skills

Leadership skills

Proficiency in Excel

Proficiency in Power BI

Education

Some college or equivalent experience in Health Information Management or business administration

Tools

Health Plan Platforms

Excel

Power BI

Notepad++

Job description

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Brief Description

Position: Team Lead, Encounter Reimbursement

Department: Claims

Reports to: Supervisor, Claims

Position Description

The Team Lead acts as the subject matter expert for Provider Contracts/Encounter analysts within the team, reporting all contracts/encounter records within the SLAs for each Payor. They serve as a liaison between the Supervisor and team members, ensuring compliance with applicable laws, regulations, and company policies.

Office Location

• 7600 North 16th Street, Suite 140 Phoenix, AZ 85020 (Remote)

Responsibilities and Duties

1. Main point of contact for Claim Encounters/Reimbursement team.
2. Participate in data encounter meetings and escalate issues as needed.
3. Oversee processing of data encounters, fee schedules, and reimbursement methodologies per policies.
4. Ensure data encounter rejections are corrected and reported according to contract SLAs.
5. Track and analyze encounter results, providing solutions and enhancements to improve acceptance records.
6. Manage systemic tickets with vendors for modifications or new requests.
7. Implement testing protocols for new encounter configurations.
8. Support employee training and quality improvement initiatives.
9. Mentor new employees and assist with process updates.
10. Generate team reports and monitor encounter transmissions.
11. Fill in for Supervisor when required to ensure coverage.
12. Manage encounter files, SLAs, and audit responses.
13. Perform other duties as assigned.

Qualifications

• Some college or equivalent experience in Health Information Management or business administration.
• 3-5 years’ experience in Medicare/Medicaid managed care, encounter data processing, healthcare analytics, or data quality assurance.
• Experience with Health Plan Platforms and fee schedules.
• Knowledge of CMS encounter data standards, 837 file formats, EDI transactions, ICD, CPT, HCPCS coding.
• Proficiency in Excel, Power BI, Notepad++.
• Strong analytical and leadership skills.

Personal Attributes

• Ability to multitask, remain calm under pressure, maintain confidentiality, and motivate others.

Job Details

• Full-time, Remote - United States

tango provides equal employment opportunities and makes reasonable accommodations for individuals with disabilities.