Supervisor Claims

Leading Edge Administrators LLC•Egypt Lake-Leto, FL

1d•Onsite

About The Position

Job Summary: The Claims Supervisor oversees the daily activities of the team responsible for processing the billing for healthcare services provided to patients. This role will develop and share knowledge of products, benefits, quality requirements and organization procedures. This position ensures claims are allowed or denied based on actual services rendered, legislative requirement and plan agreements. This position will coordinate both internally and externally by providing information and reporting.

Requirements

Associate degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience
3+ years of experience in a supervisory role in a healthcare claims processing setting where HIPPAA and HITECH standards are utilized, preferably in a healthcare TPA
Experience with benefit administration platforms such as Javelina preferred
Knowledge of Federal and State codes related to fiscal operations of healthcare services
Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10)
Ability to analyze and interpret problems in data collection, billing, and coding. Determine the source of the problem and apply a solution
Must be able to calculate and re-calculate claims, performing (sometimes complicated) calculations, applying formulas using multiplication and percentage
Solid working knowledge of standard computer applications including MS Word, Excel Outlook, and PowerPoint
Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
Communicate clearly and professionally with internal and external customers
Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
Pay close attention to detail in all aspects of the job
Make decisions using available resources and sound judgment
Maintain confidentiality and discretion
Identify and resolve problems in a timely manner, gather and analyzes information skillfully
Teach, coach, and counsel associates by effectively communicating and providing follow-up.
Open to other’s ideas and exhibits a willingness to try new things.
Demonstrate accuracy and thoroughness; monitor work to ensure quality.
Prioritize and plan work activities to use time efficiently.
Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
Follows instructions, responds to direction, and solicits feedback to improve.
Act in such a way to instill trust from management, other associates, as well as customers

Nice To Haves

Experience with benefit administration platforms such as Javelina preferred

Responsibilities

Effectively manage the performance of the Claims Team by providing daily leadership and support, coaching, feedback, and direction, incorporating positive feedback and reward mechanisms
Monitor inventory levels and aging of claims and queues to assign work daily.
Hire and manage staffing levels to ensure continuous, quality processing
Conduct effective resource planning to maximize productivity and turn-around time
Follow and maintain knowledge of Federal and State regulations as well as client requirements; implement changes regarding claims and billing standards
Develop, revise, and monitor metrics to meet quality, time, service and productivity goals
Provide expertise and general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims
Identify and coordinate resources for re-work
Analyze and identify trends and provide robust reports
Conduct regular meetings with staff toward improving performance, quality and documentation
Conduct training for new hires and ensure the ramp-up to required metrics is on track