Job Summary

The Payer Correspondence Team Leader is responsible for overseeing the daily operations of the payer Correspondence, Patient Accounts and Front-End Services team, ensuring timely review, analysis, and resolution of insurance payer communications related to claims, denials, appeals, refunds, requests for information, and payment disputes. Patient Accounts and FES WQ’s are reviewed and ensured the team is completing them within TAT, timely reporting of daily & weekly activities. The role involves managing team performance, driving productivity and quality, ensuring compliance with payer requirements, and collaborating with internal stakeholders.

Key Responsibilities

Team Leadership

• Monitor daily workloads and      allocate resources to meet operational goals.
• Conduct regular performance      reviews, feedback sessions, and coaching activities.
• Identify training needs and      ensure continuous skill development.

Management

• Oversee the review,      categorization, and processing of daily work plans for all the 3      departments.
• Ensure timely action on denial      letters, appeals responses, medical record requests, refund requests,      recoupments, and other payer communications.
• Prioritize high-impact      correspondence affecting cash flow and aging accounts.
• Monitor correspondence-related      KPIs and drive resolution of outstanding accounts.
• Escalate complex payer issues      and identify root causes of recurring denials.
• Conduct quality audits and      implement corrective action plans.
• Maintain documentation standards      and reporting accuracy.

Reporting & Analytics

• Track productivity, turnaround      time, aging, and quality scores.
• Prepare daily, weekly, and      monthly operational reports.
• Analyze trends and recommend      process improvements to enhance efficiency and reimbursement.

Process Improvement

• Develop and implement best      practices.
• Participate in process      optimization initiatives and automation projects.
• Support transition,      cross-training, and continuous improvement activities.

  Required Qualifications

• Any bachelor’s degree 
• 4+ years of experience in      Healthcare Revenue Cycle Management, min 1 year with Nimble.
• Currently on a Sr Associate or      SME. 
• Strong knowledge of insurance      claims processing, denials, appeals, and payer correspondence workflows,      and thorough knowledge of patient accounts and front-end services.

Required Skills

• Team leadership and people      management
• Analytical and problem-solving      skills
• Strong communication and      stakeholder management
• Revenue cycle and payer process      knowledge
• Performance management and      coaching
• Time management and      prioritization
• Data analysis and reporting
• Process improvement mindset
• SLA adherence
• Team engagement and retention