Claims Supervisor

Rogers Behavioral Health•Oconomowoc, WI

About The Position

The Claims Supervisor is responsible for overseeing the billing and claims activities at Rogers Behavioral Health. This supervisor works closely with the manager of insurance follow up/Patient Financial Services (PFS) department to manage the overall direction, coordination, and evaluation of staff members and workflow. This role also supervises staff to ensure quality performance and efficiency and promotes awareness of and adherence to departmental processes, policies, and goals.

Requirements

High school diploma or equivalent required.
Associate’s degree in management, healthcare or related field. Experience considered in lieu of degree.
A minimum of three (3) years of relevant experience in billing and collections.
One to two years of supervisory experience and/or position with increasing responsibilities.
Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical terminology.
Superior knowledge of payer guidelines, reimbursement, follow-up, and collections practices and experience working with third-party governmental payers.
Ability to analyze, collect, and interpret data trends; identify opportunities for improvement; and develop and implement policies and procedures.
Ability to coordinate, direct, and supervise the work of others.
Ability to collaborate with leaders from other departments.
Superior interpersonal, organizational, problem-solving, and customer service skills.
Proficiency with Microsoft Word, Excel, Outlook, Teams, OneNote and Oracle Health Patient Accounting systems.
Self-starter attitude; comfortable with working independently.
Ability to work quickly and effectively in a fast-paced detail-oriented environment while adhering to deadlines.

Responsibilities

Supervises a team of billing and claims specialists, providing guidance, coaching, and support to ensure high performance and professional growth.
Fosters a collaborative environment and promotes continuous improvement of billing processes.
Oversee the accurate and timely billing of all claims, ensuring compliance with insurance policies, regulations, and contractual agreements.
Addresses and resolves any discrepancies or issues with claims billing, including identifying and correcting errors.
Plans and coordinates various activities and daily workflows associated with insurance follow-up; accepts and passes down directions received from department manager and system administration.
Assigns duties, provides instructions, and ensures staff maintain appropriate workloads.
Ensure staff are actively and appropriately communicating with payers regarding past due and denied claims to make sure proper reimbursement is received.
Reviews claim rejection trends in collaboration with managers and claims staff to develop improvement initiatives; communicate with payers to resolve issues and foster working relationships.
Escalates trends to leadership when necessary.
Assists with denial resolution and timely rebill of claims when appropriate.
Maintains knowledge of industry data and regulatory changes; ensures staff are appropriately educated about and compliant with payer guidelines, state and federal regulations, and industry updates.
Establishes departmental objectives and works with staff to set individual goals; monitors staff performance, performs reviews, and compiles productivity reports for managers.
Works with managers to develop, review, and revise policies and procedures to maintain the efficacy of the department.
Communicates any operational changes and/or improvement initiatives to claims staff; provides education and training as needed.
Meets regularly with leadership from other departments to review performance, align strategies, identify best practices, and improve collections.
Oversee recruiting, hiring, and training practices; monitors and provide performance appraisals for new staff.
Fosters collaborative environment that encourages teamwork, communication, performance recognition, and attention to goals; works to achieve and maintain low attrition rates.