Recovery Supervisor

CERIS•Fort Worth, TX

21h•Remote

About The Position

The Recovery Supervisor is responsible for analysis and monitoring of claims audit data across multiple platforms. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and claims processing. 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.

Requirements

Ability to work independently and use critical thinking
Detailed knowledge of pay reimbursement methodology
Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
Strong understanding of healthcare revenue cycle and claims reimbursement
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, which required heavy involvement in bill review processing of claims
3+ years of relevant experience or equivalent combination of educations and work experience
Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable

Nice To Haves

2+ years of previous supervisory/management or project management experience a plus
Associate degree or higher preferred

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
Analyzes all forms of Revenue Cycle transactions and provides trend analysis
Produces daily, monthly and annual evaluative and statistical reports, analyzing drivers of variances from period to period in order to ensure the integrity and accuracy of revenue cycle data
Evaluates integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances
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)
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
Ability to review and understand case rates, per diems, percentage of discounts, and provide detailed charges and costs per claim
Handles escalated requests from client and/or executive leadership
Ensure strict confidentiality of all medical records, PHI, and PII
Additional duties as assigned