Claims Processing Supervisor

AllCare Management Services•Grants Pass, OR

15h•$26 - $32•Hybrid

About The Position

The Claims Processing Supervisor ensures that all internal and external departmental performance requirements are consistently met. This role oversees the day-to-day activities of the claims processing team, determines work assignments and efficient workflows to meet contractual obligations, and serves as a hands-on resource for staff on training, questions, and claims processing best practices.

Requirements

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others.
Highschool Diploma or equivalent required.
2–4 years' experience in managed care, Medicare, and/or Medicaid claims processing (or an equivalent combination totaling at least 2 years), with a solid understanding of core claims concepts such as co-pays, deductibles, co-insurance, coordination of benefits, and pre-existing conditions, and demonstrated knowledge of claims workflows and adjudication practices.
Extensive knowledge of medical terminology and coding systems, including ICD-9, ICD-10, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Diagnosis Related Grouper (DRG), Resource Utilization Groups (RUG), and Health Insurance Prospective Payment System (HIPPS) codes.
Knowledge of CMS 1500, UB-04, and other applicable claim forms, both paper and electronic.
Ability to research and resolve errors resulting in refunds and adjustments.
CPC, CPMA, CPCB or CPC-P coding Certification required to be obtained within 12 months of hire.
Familiarity with the Healthcare industry.
Exceptional writing, editing, and proofreading skills.
Excellent organization and time-management skills.
Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
Knowledge of and compliance with HIPAA regulations.
Excellent at breaking a project into definable and measurable tasks and tracking progress to completion.
Knowledge of research methodologies and/or data analysis.
Excellent at interpreting data and using it to solve problems and gain new insights.
Excellent at locating information and synthesizing information from various sources.
Knowledge of customer service and service recovery best practices.
Excellent customer service skills to respond appropriately and interact positively with upset customers.
Knowledge of phone customer service best practices and experienced with multi-line call centers.
Knowledge of training best practices and adult learning principles.
Excellent at training development and/or delivery.
Knowledge of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply concepts of basic algebra and geometry.
Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.
Ability to solve practical problems and work with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
The employee must occasionally lift and/or move up to 10 pounds.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is occasionally required to stand; walk and reach with hands and arms.
The noise level in the work environment is usually moderate.

Nice To Haves

Bachelor's degree (BA) from a four-year college or university preferred; or equivalent combination of education & experience.
Prior supervisory, lead, or training experience preferred.
The employee must be able to work onsite as needed.
The employee may be able to work from a home office occasionally.

Responsibilities

Provide one on one support, initial training for new hires and monthly mandatory training sessions for all claims processing staff.
Establish and maintain a professional, supportive, provider service-oriented workplace culture with high standards of individual and team performance.
Maintain production and quality monitoring logs and reports for both individual and overall departmental performance.
Assist in maintaining and monitoring internal audit procedures to ensure staff compliance with policies.
Support internal audit procedures to ensure staff compliance with company policies and procedures.
Ensure desktop procedures are followed consistently and provide retraining as needed.
Maintain and support department policy guidelines for HIPAA and PHI compliance.
Review, create, maintain, and update desktop procedures and reference materials for claims processing staff.
Assist in developing and updating relevant policies, procedures, and training materials.
Learn and maintain a working understanding of the job duties of all positions supervised.
Organize workflow and delegate responsibilities to reporting staff, including coverage during absences.
Monitor team productivity and provide regular, constructive feedback.
Identify and resolve workplace issues, including attendance and performance concerns.
Conduct annual performance evaluations for direct reports.
Prepare clear, detailed documentation of employee conversations and disciplinary actions.
Communicate needed system changes, process improvement ideas, and staff concerns to the direct supervisor.
Effectively communicate to your direct supervisor any needed system changes, ideas for department process improvements, concerns, and staff issues.
Respectfully takes direction from the Sr. Claims Processing Manager and or the VP, Claims Administration & Payment Integrity.
Demonstrates effective behavior and communicates in a respectful and professional manner.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Meets all required training including those listed in Relias Learning Module System (LMS).
Performs other duties as assigned.
Directly supervises 9 to 11 (nine to eleven) employees in the Claims department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.