Health Management Systems, Inc. TPR Team Lead in Irving, Texas

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for a Third Party Resource (TPR) Team Lead who is responsible for leading a team in Third Party verifications ensuring production and quality standards are met.

Essential Responsibilities:

  • Leads assigned team of TPR Specialists in the research/eligibility verification process; ensures production and quality standards are met.

  • Performs as subject matter expert in all aspects of TPR verifications process.

  • Manages daily inventory of work and distributes team assignments according to schedule and ensuring deliverables and business needs are met.

  • Acts as an escalation point to assigned team members and handles more difficult verifications.

  • Provides back up support for all functions of a team.

  • Trains, coaches and trains all new TPR Specialists.

  • Answers questions from team members and helps with issues as they arise.

  • Processes escalation requests from client vendors, providers and members.

  • Processes Good Cause requests for approval/denial of TPL.

  • Processes requests for new Carrier Codes.

  • Monitors supplies and sends requests to order supplies for the unit.

  • Monitors departmental equipment/software and notifies Supervisor or Help Desk of any issues.

  • Suggests areas for process and procedural improvements.

  • Develops end of month figures for monthly reports.

Non-Essential Responsibilities:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Ability to analyze information and use logic and process knowledge to address work-related issues and problems

  • Ability to be detail-oriented

  • Ability to build relationships both in person and over the phone

  • Ability to work proficiently with company software used on the project (i.e. Microsoft Word, Excel, ImageNow, etc.)

  • Ability to navigate various websites

  • Working knowledge of HIPAA privacy and security rules

  • Ability to organize well and multi-task

  • Ability to perform well in team environment

  • Ability to meet deadlines and work independently

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 10% of time based on business needs

Minimum Education:

  • High School Diploma or GED required; Associate’s degree preferred.

Minimum Related Work Experience:

  • 3 years work experience in a production and quality based environment, preferably in verifications/QA insurance eligibility.

  • Customer call center environment experience.

  • Knowledge of state Medicaid systems.

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Title: TPR Team Lead

Location: Texas-Irving

Requisition ID: 180010BM

EEO/Minorities/Females/Protected Veterans/Disabled.