Appeals Supervisor

CorVel Career Site•Fort Worth, TX

1d•$23 - $34•Remote

About The Position

The Appeals (Provider Relations) Supervisor is responsible for daily operations within the Provider Relations department. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests along with appeal submissions. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers. This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Manage team performance by setting and communicating standards and deadlines, measuring results, and providing feedback. Maintain positive morale by leading the team through example and accountability with a focus on helping each member achieve their best performance. Assists leadership in obtaining complex information from various financial, clinical and operational systems and data sources Ability to assist with pricing of claims according to provider contracts. Ability to assist team with problem solving regarding customer complaints, or inquiries, including bill review disputes verbally and in written communication. Identifies, quantifies and monitors account detail or workflow processes for barriers. Makes process improvements or initiates courses of action for problem resolution. Participates in the panel interviews, prepares new hire documentation, facilitates associate orientation, and participates in the termination process (i.e., documents performance issues, recommends disciplinary actions) Responsible for ensuring new employees are oriented to the organization, its policies, facilities etc Supervisors should also provide ongoing guidance to employees, often in the forms of ongoing career coaching, counseling and performance appraisal Independently leads initiatives as assigned by management, coordinating task teams or other forums to deliver results as identified and/or determined by leadership. Provides formal updates and closure Handles escalated requests from clients and/or executive leadership Ensure strict confidentiality of all medical records, PHI, and PII Additional duties as assigned. KNOWLEDGE & SKILLS: Ability to work independently and use critical thinking Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable) MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet Strong analytical and problem-solving skills Strong attention to detail and ability to deliver results in a fast paced and dynamic environment Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovative Ability to think and work independently, while working in an overall team environment EDUCATION/EXPERIENCE: 5+ years of relevant experience in a medical or insurance field 3+ years of previous supervisory/management or project management experience a plus 3+ years of relevant experience or equivalent combination of educations and work experience Associate degree or higher preferred Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $22.63 - $33.77 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

Requirements

Ability to work independently and use critical thinking
Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet
Strong analytical and problem-solving skills
Strong attention to detail and ability to deliver results in a fast paced and dynamic environment
Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovative
Ability to think and work independently, while working in an overall team environment
5+ years of relevant experience in a medical or insurance field
3+ years of previous supervisory/management or project management experience a plus
3+ years of relevant experience or equivalent combination of educations and work experience
Associate degree or higher preferred
Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable

Responsibilities

Manage team performance by setting and communicating standards and deadlines, measuring results, and providing feedback.
Maintain positive morale by leading the team through example and accountability with a focus on helping each member achieve their best performance.
Assists leadership in obtaining complex information from various financial, clinical and operational systems and data sources
Ability to assist with pricing of claims according to provider contracts.
Ability to assist team with problem solving regarding customer complaints, or inquiries, including bill review disputes verbally and in written communication.
Identifies, quantifies and monitors account detail or workflow processes for barriers.
Makes process improvements or initiates courses of action for problem resolution.
Participates in the panel interviews, prepares new hire documentation, facilitates associate orientation, and participates in the termination process (i.e., documents performance issues, recommends disciplinary actions)
Responsible for ensuring new employees are oriented to the organization, its policies, facilities etc
Supervisors should also provide ongoing guidance to employees, often in the forms of ongoing career coaching, counseling and performance appraisal
Independently leads initiatives as assigned by management, coordinating task teams or other forums to deliver results as identified and/or determined by leadership.
Provides formal updates and closure
Handles escalated requests from clients and/or executive leadership
Ensure strict confidentiality of all medical records, PHI, and PII
Additional duties as assigned.