Claims Supervisor

Volunteers of America National Services (VOANS)•Eden Prairie, MN

4d•$79,000 - $94,000•Remote

About The Position

Volunteers of America National Services (VOANS) is seeking a Claims Supervisor to join their PACE team. This is a remote role where the individual will maintain the integrity and accuracy of the claims processing system across all PACE programs. This is a mission-driven healthcare organization that is proudly Great Place to Work® Certified for 8 consecutive years.

Requirements

Associate’s degree in Healthcare or Business Administration or closely related field; or a High School Diploma and minimum four (4) years of healthcare operations experience.
Minimum two (2) years of claims processing experience in an insurance or managed care environment.
Ability to communicate and work effectively with various levels of facility and VOA/VOANS staff and providers.
Knowledge of HIPAA law.
Thorough knowledge of CPT, HCPCS, ICD-10, CM and DRG coding required.
Knowledge of PACE regulations.
Ability to handle interruptions on a regular basis as well as the stress associated with meeting a variety of deadlines.
Ability to operate computerized equipment.
Ability to meet the requirements identified as indicated in the primary job functions.
Ability to work flexible hours.

Responsibilities

Oversee and manage in-house claims processing and operations across all VOANS PACE Organizations.
Monitor working claims inventory daily in accordance with the Claims Inventory Management SOP, including managing timely processing, priority claim processing, and claims hold management.
Report department activities, including resolutions implemented and escalation of issues that fall outside of standard processes or expected patterns, to the Director of Health Plan Operations.
Supervise Claims Adjudicators, Claims Processor, and other claims personnel, including conducting performance evaluations, interviewing, hiring and onboarding, counseling and disciplinary actions.
Oversee development and implementation of claims processing and support policies and procedures to ensure seamless and efficient claims adjudication.
Monitor productivity to ensure claims are processed in a timely, accurate and compliant manner.
Monitor key performance indicators (KPIs) identified by leadership for claims processing, ensuring continuous improvement and adherence to service level agreements.
Prepare routine reports for the Director of Health Plan Operations on claims KPIs, inventory, monthly claim payments, contracted rates, financial recordkeeping, and other activities.
Organize and suggest resolution to escalated claims issues, providing clear direction to ensure thorough investigation and coordination takes place for resolution of problems, including reporting resolution and status updates to leadership.
Support various projects from across the PACE Organizations and community-based program enterprise.
Assist with other duties and projects as assigned.