Claims Account Lead - DSO

Who We Are At OrthoFi, we're not just another player in the orthodontic industry - we're the driving force that helps orthodontists launch more smiles while ensuring top-tier patient care. Our tech-savvy solutions are the secret sauce that empowers orthodontic practices across the United States. With a track record of supporting over 2,000 practices, and in partnership with OrthoBanc, we've unlocked access to quality, affordable orthodontic care for a whopping 3.2 million patients and counting! Picture this: Our cutting-edge Patient Acquisition software combined with our expert Revenue Cycle Management solutions propels practices to achieve jaw-dropping 13% year-over-year growth. Plus, when it comes to patient and insurance billing, our collection results leave competitors in the dust. Behind our mission is a dynamic team of around 300 passionate individuals. Our headquarters is based in Denver, CO, with employees spread across several states. Join us in our quest to transform the orthodontic landscape - where innovation meets dedication, and starting more smiles are just the beginning. Our purpose is to radically improve the way patients access and pay for quality elective care. Diversity, equity, and inclusion (DEI) ensures we can fulfill our purpose by creating a better, more equitable and inclusive workplace for our community members and healthcare experience for all. By focusing on DEI, we are working towards our mission of connecting more patients with quality orthodontic and dental care and helping make treatment accessible to over 1 million patients a year by 2025. Equity is core to our mission to serve patients, and DEI is embedded in our core values, especially "seek diversity," and "do what's right."" OrthoFi is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunities regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. About the Role As a Claims Account Leader you play a very important role in ensuring we create the best possible experiences for practices who chose to partner with OrthoFi. You will work hand in hand with our practice facing teams to stay abreast of what our customers care most about and partner with our internal claims teams to ensure Orthodontic claims are processed without delay. Your mission will be to establish a strong relationship with practice representatives, communicate as needed, and keep a constant eye on their overall claims health. In doing so our practices will be to rest assured that OrthoFi is working tirelessly to collect their insurance payments and allow them to focus on delivering quality Orthodontic care. What You Will Do: Consistently exhibits the attitude and aptitude of a Sr. Coordinator, plus: • Takes a proactive approach to practice performance and issue resolution. • Ability to think "big picture" with an acute understanding of how OrthoFi's Insurance A/R performance impacts a customer. • Takes a highly collaborative, team first approach to delivering outstanding results for our customers. • Maintain constant communication with team leads and managers responsible for managing back-office claims teams. • Advocate for process / product improvements that lead to improved customer experiences. • Proactively manages practice AR/Claims issues prior to becoming Practice Facing. • Proactively partners with OSM team to solution challenges for Practice AR/Claims. • Ability to meet and exceed production and quality metrics on a consistent basis. • Assist with training or other upscaling initiatives (as needed) for coordinators who are part of your POD. • Collaborate with practice facing teams on matters pertaining to insurance claims for customers within an assigned POD. • Manage and track the completion of special projects needed to address practice specific needs. • Monitor cases escalated from practice facing teams, take action, and communicate resolution directly to the customer. • Proactively review insurance AR Aging trends and take actions to mitigate issues leading to excessive aging. • Review Facts, determine appropriate actions, and provide timely resolution to escalations raised outside of normal support channels. What You Will Bring: • Expert knowledge and experience of the dental revenue cycle and dental/ortho industry standards. • Ability to identify trends, root causes and solutions. • Subject Matter Expert for claims department. • Ability to create and implement claims processes for better efficiency and productivity. • Proficient in ConBen processes and knowledge. • Complex PPA Knowledge. • Proficient in Escalations. • Proficient in Tableau, Google Sheets and/or Excel with the ability to create and share reporting in partnership with the Claims Team Lead and OSMs on a regular basis. • Mastery of all queues and segments. • Demonstrates the ability to multitask and work on several initiatives throughout the course of a work day or work week. • Excellent written and verbal communication and active listening. NOTE: For non Queue production work, a separate production metric will be determined by your Lead or Manager. This would include refund work. • Must meet daily production goal of 30 claims per day. • Consistent week over week QA score of 95%. • Practice AR performance, maintain 4% or less of AR over 30 days for supported practices. Promotions from a CAL role to a Team Lead role will occur based on business need. When a new role is available, it will be posted internally and interviews will be conducted. The following are key components of the promotions decisions in these situations. To be eligible for promotion to a Team Lead role, a CAL must meet the following requirements: • 6+ months tenure in a CAL role. • Consistent track record of exceeding performance expectations. • Demonstrated positive, team first attitude and exhibits OrthoFi's core values. • Meet Claims Attendance Policy expectations. • Have no progressive disciplinary action (verbal or written) for at least the last 90 days. What's in it for you... • Full medical, dental, and vision benefits with 100% employer paid options • 401(k) match • Supportive culture with one-of-a-kind growth and development opportunities • Option to work from home or in the office • Employer HSA contribution • Paid Parental Leave • Company and team outings • Peer-to-peer recognition program • Company sponsored premium subscription to the Calm app • Vendor discounts Compensation: $23 - $28/hour Please note that the compensation information that follows is a good faith estimate for Colorado-based hires only and is provided pursuant to the Colorado Equal Pay for Equal Work Act and Equal Pay Transparency Rules. Work Authorization: You must be authorized to work for any employer in the US. Apply tot his job Apply To this Job