Position Summary

The Indiana Medicaid Team Lead is dedicated to the Medicaid follow-up team and is responsible for leading a team of Medicaid Follow-Up employees. The Team Lead provides day-to-day operational leadership and payer-specific expertise to ensure Medicaid claims are billed, followed up, appealed, corrected, and resolved accurately and within all applicable filing and appeal timeframes. This role requires in-depth knowledge of the Indiana Medicaid claims process, including Traditional Medicaid and all Indiana Medicaid managed care payers, and serves as the team’s primary subject-matter expert and escalation point.

Primary Priority

The main priority of this position is to maintain current, working expertise in Indiana Medicaid requirements and use that expertise to drive timely, compliant, and effective resolution of Medicaid accounts across Traditional Medicaid and all managed care payers.

Essential Duties of the Position

• Lead the Medicaid Follow-Up team and maintain clear ownership of project priorities, inventory, productivity, quality, and account-resolution outcomes.
• Serve as the subject-matter expert for Indiana Medicaid claims, including Traditional Medicaid and all current Indiana Medicaid managed care payers.
• Maintain thorough knowledge of payer-specific billing rules, timely filing limits, reconsideration and appeal deadlines, corrected-claim requirements, authorization rules, coordination-of-benefits requirements, and escalation pathways.
• Monitor payer bulletins, manuals, portal updates, contractual guidance, and regulatory changes; promptly translate changes into documented procedures and team training.
• Ensure claims are submitted correctly and that denials, rejections, underpayments, no-response claims, and other unresolved balances receive timely and appropriate follow-up.
• Develop, maintain, and enforce Client- and payer-specific workflows, job aids, escalation standards, and account documentation expectations.
• Review inventory by payer, aging, dollar balance, denial category, timely filing risk, and work-queue status; assign and rebalance work based on priority and staff capacity.
• Identify claims at risk of timely filing or appeal expiration and ensure immediate intervention and escalation.
• Audit account activity for accuracy, completeness, compliance, appropriate next steps, and effective use of payer portals and client systems.
• Analyze denial and payment trends, identify root causes, and partner with clients, CBS leadership, billing, coding, registration, authorization, and other stakeholders to resolve systemic issues.
• Provide timely reporting to CBS leadership and client stakeholders regarding inventory, aging, productivity, quality, denials, escalations, barriers, and recovery results.
• Interview, hire, onboard, train, coach, evaluate, and, when necessary, discipline assigned employees in accordance with company policy.
• Set clear performance expectations and provide side-by-side coaching, ongoing education, and documented feedback to strengthen staff knowledge and results.
• Resolve complex account and payer issues escalated by team members, patients, clients, or internal departments.
• Protect patient information and ensure compliance with HIPAA, client requirements, payer rules, and Complete Billing Services policies and procedures.
• Perform other related duties as assigned.

Essential Duties of the Position

Daily

• Monitor Medicaid work queues, inventory volume, aging, balances, wait dates, payer responses, and deadline-sensitive accounts.
• Assign and prioritize work by payer, filing or appeal deadline, balance, denial type, and operational need.
• Answer staff questions and provide hands-on assistance with complex claims, payer portals, client systems, correspondence, appeals, and escalations.
• Monitor workflow adherence, productivity, quality, attendance, and emerging training or performance concerns.
• Communicate material payer, access, system, or workflow barriers to the appropriate CBS and client stakeholders.

Weekly

• Complete and document quality audits for each assigned employee, including review of account notes, actions taken, follow-up timing, and payer-specific accuracy.
• Review high-dollar, aged, denied, stalled, and timely-filing-risk inventories and establish corrective action plans.
• Review team performance dashboards and provide side-by-side coaching or targeted training when needed.
• Meet with CBS leadership and applicable client stakeholders to review progress, barriers, escalations, and priorities.
• Verify timecards, attendance occurrences, and overtime authorization for assigned staff.

Monthly

• Complete employee scorecards and performance reviews against established productivity, quality, aging, and resolution goals.
• Summarize project performance, including inventory movement, denial trends, recoveries, payer barriers, deadline exposure, and recommended improvements.
• Delivering ongoing Medicaid and payer-specific education based on audits, trends, policy updates, and recurring errors.
• Review and update Medicaid procedures, payer reference materials, escalation contacts, and training resources.

Required Knowledge, Skills, and Qualifications

• In-depth, current knowledge of the Indiana Medicaid claims and reimbursement process, including Traditional Medicaid and Indiana Medicaid managed care payers.
• Demonstrated knowledge of payer-specific claim submission, eligibility, authorization, denial, corrected-claim, reconsideration, appeal, recoupment, and timely filing requirements.
• Working knowledge of institutional and professional claims, including UB-04 and CMS-1500 billing requirements.
• Prior healthcare revenue cycle, Medicaid billing, or insurance follow-up experience; direct Indiana Medicaid follow-up experience is required.
• Prior leadership, supervisory, or team-lead experience with demonstrated ability to direct work, coach employees, manage performance, and resolve conflict.
• Strong analytical skills and the ability to use inventory, denial, aging, quality, and productivity data to establish priorities and improve results.
• Strong written and verbal communication skills, including the ability to explain complex payer requirements clearly to staff and stakeholders.
• Excellent organization, attention to detail, follow-through, and ability to manage competing deadlines with a high degree of accuracy.
• Ability to build effective working relationships with client representatives, payer contacts, employees, leadership, and cross-functional teams.
• Working knowledge of HIPAA, privacy, security, and applicable healthcare compliance requirements.

Preferred Qualifications

• Experience leading a Medicaid follow-up or accounts receivable team in a hospital or healthcare revenue cycle environment.
• Experience with client health systems, workflows, or account inventories
• Experience using payer portals, electronic claim systems, electronic health record systems, and revenue cycle work-queue platforms.

Difficulty and Scope of Work

The position requires independent judgment, strong technical Medicaid knowledge, and the ability to manage multiple payer requirements and deadlines simultaneously. The Team Lead must recognize financial and compliance risk, resolve complex account barriers, prioritize work across a high-volume inventory, and provide clear direction to the team while maintaining productive relationships with clients, payers, and internal departments.

Working Relationships

This position routinely interacts with the assigned Medicaid Follow-Up team, CBS leadership, clients’ stakeholders, payer representatives, and supporting revenue cycle departments. The Team Lead is expected to communicate professionally, escalate issues promptly, and foster a collaborative, accountable, and solutions-focused work environment.