Job Description

As the leader of the Medical Support Reps, you will lead a team of “bill coders” to successfully achieve business objectives and meet team goals.  The team handles medical bills from the payor side of the business making sure the injured workers’ medical bills are paid correctly.  As you Lead the team, you will seek out and implement process improvements to increase efficiencies and maintain or improve service results.   Monitoring workflow, guiding training and conducting regular conversations with you team to ensure they are successful is a key function in this role. 

As a leader, you will provide direction to your team members by overseeing workloads, conducting performance reviews and inspiring others to do their best work while communicating the Organization’s vision and expectations. 

This is a hybrid role, so some office time is need.

Our benefits include:

• Affordable Medical, Dental, Vision Insurance, HSA, FSA
• Traditional and Roth 401(k) plans with company match
• Company contributions to help pay off student loans
• Monthly home internet allowance
• Free life insurance, STD & LTD
• Opportunities for annual gainshare bonus 
• Pet insurance
• Generous PTO
• 9 paid holidays 
• Paid parental leave
• Annual company-wide volunteer day
• Adoption financial assistance

What You Will Be Doing:

• Works in collaboration handling bill review software vendor and develops a working knowledge of all SFM business rules added to the vendor bill review system and attends meetings as needed to review service/quality issues. 
•   Identifies improvement opportunities and keeps abreast of mandated rules, procedures, and forms. This includes development of expertise in business processes and bill review handling in core states. Communicates modifications and recommendations as needed.  
• Proactively meets with the various business teams to ensure the medical services representatives are following the internal policies, practices and procedures, workflow/service issues are managed correctly. Maintains appropriate interactions with persons both within the organization and externally.
• Works with PPO networks and research’s other medical cost savings tools and services and makes recommendations for areas of improvement.
• Participates in industry associations and conferences related to bill review functions.
• Works with the analyzation and creation of bill payment documentation.
• Handles complex and escalated medical billing/coding issues, complicated requests, complaints, and unique service issues.
• Researches, analyzes, and updates ICD, CPT, HCPC and DRGs as needed.
• Directs and schedules meetings related to medical support representatives’ activities and participates in special projects.
• Creates and analyzes staff audit reports and reviews bills processed by staff which may be used as part of their performance.
• Monitors the various business queues to determine the efficiencies of the queues and analyzes the workflow needs to develop expectations for staff.
• Stays current on workers compensation statutes and rules for all SFM jurisdictions and ensures that the vendor has incorporated changes as needed.
• Uses latest technology and relies on best practices to identify, develop, and implement business solutions to improve business needs and training materials.
• Audits files and identifies training issues through the use of regular questions and routine dialogue and measures overall medical support team results against defined success measurements.
• Attends medical conferences at MN DOLI as needed to defend SFM billing decisions and assists with disputes that may arise in other states of operation.

Leadership and Team Member Development  

• Develops and communicates vision and expectation levels to team members and relates them to corporate vision and strategic direction. Maintains appropriate interactions with persons both within the organization and externally.
• Provides team members with the tools needed for the team to accomplish stated objectives and fosters a positive and rewarding work environment and monitors team dynamics and safety practices.
• Consistently provides feedback and communication to staff members related to company and team performance.
• Leads team members to make decisions based on established criteria/goals and monitors performance to achieve successful results.
• Defines and develops team member’s job, responsibilities, and accountabilities, in both a physical and virtual environment.
• Selects, coaches, and retains staff. Inspires team members to attain goals and pursue excellence while identifying opportunities for improvement and provides constructive suggestions for improved performance.
• Partners with and uses Human Resources as a resource for talent acquisition, training, and performance management.
• Provides training and development opportunities. Identifies and develops future leadership within the team.  Challenges team members to develop professionally or as leaders while serving as a role model and mentor.
• Reviews team job descriptions and duties on a regular basis and makes adjustments as business requirements change. Ensures that proper cross training occurs to cover for volume peaks and team PTO.

Business Operations:

• Develops and applies team policies, practices and procedures and seeks opportunities to improve strategies that impact the business.
• Seeks opportunities to improve upon or develop processes that could be used to enhance the service provided to agents, policyholders, injured employees and internal customers.
• Develops and implements document retention policies, and partners with the Compliance team to ensure company business rules are adhered to.
• Identifies, develops and implements business solutions to business needs and special projects and may include a heavy emphasis on technology, including working closely with IS staff on system development from a user perspective and seeks ways to improve efficiencies and improvements within the Team.
• Identifies and implements policies, practices and procedures and communicates these best practices to the Insurance Operations team and ensures operational compliance with best practices and quality assurance standards.

Qualifications We're Looking For:

• Bachelor’s degree or equivalent work/education experience.
• Seven years’, or more, experience working in a customer focused business environment and or insurance service operations department, or similar environment.
• Experience dealing with bill coding, medical billing practices, appeals, and knowledge of payor policies with a wide range of provider types is needed.
• Experience working in workers’ compensation insurance preferred.
• Certification from either American Academy of Professional Coders (AAPC) or America Health Information Management Association (AHIMA).
• Workers’ compensation and/or casualty insurance experience is highly desirable.
• Experience managing, leading projects or other similar experience leading people.
• Demonstrated effective leadership skills.
• Must be motivated to develop an effective team environment focused on team results.
• Strong coaching and development skills, with desire to guide and encourage staff toward improved performance and quality work.
• Willingness to inspire innovation and drive for continuous quality improvement.
• Must serve as a positive role model to business team members.
• Must be able to see the big picture and have a strategic approach to team management.
• Must be motivated to serve as a positive role model to all team members.
• Ability to apply confidentiality when appropriate.
• Strong listening, written and verbal communication skills, with ability to communicate at all levels within the organization.
• Strong organizational skills including the ability to manage multiple projects and work with minimal direction.
• Excellent documentation skills with knowledge of understanding correct methods of creating documentation.
• Ability to interact with others effectively by utilizing good communication skills, cooperating purposefully, and providing information and guidance, as needed, to achieve the business goals of the company.
• Ability to manage difficult situations and conversations with diplomacy.
• Excellent problem solving, decision making and organizational skills.
• Strong computer skills, including MS Office applications and knowledge of imaging and mail service functions.
• Ability to delegate to ensure successful completion of projects and/or assignments.
• Able to be on business premises as needed.

Physical Requirements

Regular attendance is required. Work takes place in a semi paperless environment within an in office or home office setting, using standard office equipment such as computers, phones, and photocopiers, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear, and maintain concentration and focus. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

About SFM

Since 1983, our mission has been to be the workers’ compensation partner of choice for agents, employers and their workers. In that time, we’ve expanded to a little over 22,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, safe patient handling, loss prevention, medical services and more. Though much has changed through the years, our focus continues to be unrivaled customer service, safety, and providing better outcomes for employers and injured workers.

SFM is unique in that we are small enough that your voice is heard but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength.

Join us!! Click "Apply" Now

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SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. SFM provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, status with regard to public assistance, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

  SFM Companies, EEO/AA Employers . SFM is a participant of E-Verify.  Applicants have rights under Federal Employment Laws. 

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