Supervisor, Coding & Claims Resolution Analysts

Medica•Minnetonka, MN

16h•Hybrid

About The Position

The Supervisor of the Coding Analysts and Claim Resolution Analysts within Operations is responsible for the Coding and Claim Teams, and providing oversight and management of issue resolution for Medica’s members and providers across all business/products. The Coding Analysts and Claim Resolution Analysts support the timely resolution of issues received from Medica’s Customer Service (members/providers – all products) and issues received directly from Medica’s key providers and leased provider networks. The supervisor is responsible for managing the team’s performance and meeting our customers’ expectations for turn-around-time. The supervisor works toward root cause analysis by partnering with internal and external (vendor) partners. The supervisor supports internal customers and works with both internal and external vendor partners. Performs other duties as assigned.

Requirements

Bachelor's degree or equivalent experience in related field
5+ years of work experience beyond degree in coding
1+ years of coding team leadership experience
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Nice To Haves

Prior claims operations experience in a health plan setting
Demonstrated problem solving skills including root cause analysis
Ability to collaborate effectively with cross-functional partners including with external partners

Responsibilities

Problem Solving, Escalated Issue Management, Relationship Management and Issue Resolution
Leverages knowledge of all Medica products, policies and processes.
Accurately interprets member and provider contracts and follows Medica’s procedures
Identifies processing errors or claim payment trends, accurately identifies the source and root cause of problems
Identifies inappropriate coding trends, claim processing trends, and system set up issues that result in errors and engages the appropriate players as necessary to develop a plan to resolve the trends
Identifies trends by analyzing complex operational issues and reviewing provider contracts, files, systems, policies and procedures to formulate clear picture of the situation, identifying cause and effects
Proactively communicates to providers, members, and internal customers within an appropriate time frame.
Documents all provider and other applicable issues in ePIL database following the established business rules.
Utilizes all software applications needed to adequately research and resolve claim issues (i.e. IDRS, ISET, Info Reports, COSMOS, Health Rules, etc.)
Team and Staff Performance Management
Supervises staff, sets objectives, coaches and develops, provides feedback and conducts annual performance reviews
Holds regular staff meetings/huddles and 1:1 meetings
Manages staffing, training, scheduling, and team morale
Promotes a positive working climate that supports open and honest communication, integrity, service quality, and innovation and is achievement-focused
Manages performance and holds staff accountable for meeting department standards.
Formulates action plans for less than acceptable performance
Project Management
Contacts and coordinates resources (other departments, vendor partners, providers) to resolve identified operational issues in an effective and timely manner
Coordinates data from provider, Siebel/Oracle reports, and customized reports to identify accurate data for claims projects
Monitors claims project status progress and communicates progress to various stakeholders (providers, network management, upper management, customer service operations, etc.)
Documents project status and resolution in ePIL as required
Effectively manages many projects simultaneously, plans and executes special projects as requested by management
Assists with companywide initiatives or changes
Leads communication to key strategic providers