Provider Services Team Leads are responsible for ensuring all processes are adhered to, metrics are met or exceeded, and documentation is created and maintained with high quality and detail. The Provider Services team is responsible for
daily communication with providers and clients – through an in-bound call queue, written correspondence, email inquiries, and out-bound calls to answer questions and resolve issues.
This role supports the CCV (Clinical Chart Validation) leadership and provides leadership to the Provider Services team. The Team Lead is tasked with ensuring the team is meeting the daily delivery of a high caliber of quality and meeting our contractual
service level agreements with our client. Our success is measured as a team. The Team Lead manages the inbound call queue, daily production tasks and client-specific manual tasks but is also regularly assigned additional responsibilities which are of a higher
complexity and require an expanded set of competencies. Some examples of such responsibilities can include:
- Developing and managing process metrics
- Developing and monitoring team goals
- Developing, monitoring and ensuring adherence to all applicable timeframes, guidelines, SOPs and SLAs
- Interdepartmental coordination for process improvement
- Troubleshoot and research complex inquires, processes and tasks
- Special Projects
Operations Management. Plans, schedules and coordinates the work of the department, working collaboratively with other Team Leads, to achieve stated goals for a call center environment. Implements and utilizes metrics to monitor and ensure
all activities are performed consistently within established company and audit guidelines. Effectively supervises assigned personnel, equipment operation and workflow. Actively monitors team performance and workload to ensure adequate task coverage and provide
quantifiable recommendations and/or feedback to management.
Provides Oversight Support. Serves as escalation path for clients, providers, auditors, audit managers, scanning operations, and others by providing leadership and direction in responding to complex inquiries and problem resolution. Actively
recommends system or process improvements or enhancements that will increase productivity, quality or cost containment.
Provides Communication Expertise. Based on client relationships, serves as a subject matter expert and key point of contact to facilitate responses for more complex inquiries and data requests from both internal and external customers.
Communicates directly with higher levels of management (client or providers) as necessary following established processes and procedures. Ensures all regulatory and Cotiviti processes regarding PHI are observed by urgently escalating all PHI (Protected Health
Meets or Exceeds Standards for Productivity. Ensures productivity goals and standards are set by the department are met. Ensures all department rules and processes are followed. Alerts internal stakeholders of system issues or other issues
impacting productivity. Provides management team with call center statistics and reports on a scheduled or ad hoc basis.
Meets or Exceeds Standard for Quality. In collaboration with Director, establishes quality standards for the group. Responsible for driving performance of the group to attain established quality standards. Develops quantifiable and reportable
performance metrics for the group. Alerts internal stakeholders of issues or concerns impacting quality of work.
Team Training and Leadership. Provides team leadership for the provider service team regarding process, procedures, and complex issue resolution. Trains staff on new or existing processes. Monitors work queues including but not limited
to email, voice mail, and ticket system to insure we are providing timely turnaround. Actively recommends systems or process improvements or enhancements that will increase productivity, quality or cost containment. Exhibits a spirit of continuous improvement
by guiding and training team on call techniques.