Prebill Denials Team Lead in Houston, TX at Parallon

Date Posted: 3/13/2018

Job Snapshot

  • Employee Type:
  • Location:
    8101 West Sam Houston Parkway South
    Houston, TX
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

The Prebill Denial Team Lead will be responsible for daily operational work flow for post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor. Provide staff support to communicate with third party payors to resolve discrepancies prior to billing. Ensure work is completed timely and efficiently and provide guidance to prebill denial staff regarding policy and procedures. Escalate denial activities issues or trends to the SSC Denial Director.
Functional areas:

  • Verification of authorization on services post discharge, prebill
  • Re-certification for additional days post discharge, prebill
  • eRequest queues as determined during program implementation
  • Track and trend root causes for prebill denials


•         Assisting staff level employees to insure compliance with corporate and department policies and procedures

•         Analyze insurance denial trends identified during daily operations

•         Ensures prebill denials identified via a Meditech reports are worked  efficiently and effectively on a daily basis

•         Identify problem accounts and escalating as appropriate

•         Update the patient account record to identify actions taken on the account   

•         Contacts facilities, physicians’ offices and/or insurance companies to resolve denials/appeals 
  • Monitor staff adherence to time and attendance policies through observation and statistical data collection; report deviations to management on a timely basis
  • Monitor staff adherence to all other policies and procedures, including phone and internet usage, break utilization, etc. and report deviations to management on a timely basis
  • Monitor staff performance and report concerns/progress to appropriate management on a timely basis
  • Perform staff QA’s and productivity reviews and provide data to manger/director

•         Participate in staff communication regarding data/feedback related to production and quality
  • Participate in new hire interviews as applicable
  • Provide input into the development and updating of staff training materials
  • Provide new hire training
  • Provide ongoing education and training as needed
  • Establish and maintain relationships with all customers, including: SSC Leadership, Hospital Leadership, payers, physicians and others as needed or required

•         Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors self-compliance and works with management to implement process changes needed to meet compliance and regulatory updates, along with quality initiatives

•         Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous

•         Adheres to established policy and procedure and standards of care;  escalates issues through the established Chain of Command

•         Demonstrates commitment to teamwork and cooperation  

•         Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”

•         Other duties as assigned

Job Requirements


•         Associates Degree in Business or related field

•         Equivalent work experience may substitute degree requirement

•         Appeals, denials, managed care contracting, or utilization review experienced preferred

•         Previous management experience preferred

•         Some travel may be required