Supervisor of Claims Research

Colorado Access•Aurora, CO

16d•$78,200 - $90,000•Hybrid

About The Position

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend. What you will do: We are looking for a SUPERVISOR OF CLAIMS RESEARCH who can help shape our vision and support our mission. Here is what the position will look like. Provides supervision and coordination of work performed by the claim research specialists. Provides feedback, coaching and counseling regarding performance. Responsible for maintaining quality assurance of all claim research activities. Performs and evaluates the results of quality reviews and takes appropriate, timely action to resolve identified concerns. Establishes and monitors workflows and inventory. Makes appropriate adjustments based on work volume, projects and other changes that impact day to day operations. Supervises the research of claims as well as special projects as requested with E-Plus. Responsible for creation and oversight of claim research reports and dashboards for internal departmental monitoring, quality and reports due to the State or other contract holders. Communicates key information within the department and to key stakeholders to ensure good coordination and effective operations. Develops and maintains policies and procedures and maintains claim research correspondence and configuration within the claim research tracking tool. Participates in performance and compliance audits conducted by the State or other contract holders. What you will bring: Education: Bachelor’s degree in business, Healthcare or related field. Equivalent combination of experience and/or education may substitute with a preference for at least five years progressive relevant work experience. Experience: Minimum of three years’ experience in processing health insurance claims; including at least two years of Medicaid and Medicare claims experience. Previous supervisory experience preferred. Knowledge, Skills, and Abilities: Solid knowledge of managed care/health insurance claims including HCPC, CPT, and ICD10 coding for Medicaid and Medicare and commercial claims. Thorough knowledge of claims processing including subrogation, reinsurance, appeals, etc. Strong written and verbal communications skills. Demonstrates support for the company’s mission, vision, and values. Strong organizational, project and time management skills. May be required to manage multiple priorities and projects with tight deadlines. Ability to work independently and propose solutions to issues identified in daily operations. Strong knowledge of computer applications and Microsoft Office. Licenses/Certifications: A valid driver's license and proof of current auto insurance will be required for any position requiring driving Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization. Pay, Perks and Benefits at Colorado Access: The compensation for this position is $78,200.00 to $90,000.00 annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status. In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes: Medical, dental, vision insurance that starts the first day of the month following start date. Supplemental insurance such as critical illness and accidental injury. Health care and dependent care flexible spending account options. Employer-paid basic life insurance and AD&D (employee, spouse and dependent). Short-term and long-term disability coverage. Voluntary life insurance (employee, spouse, dependent). Paid time off Retirement plan Tuition reimbursement (based on eligibility). Annual bonus program (based on eligibility, requirements and performance). Where you will work: This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’ We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado. Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.

Requirements

Bachelor’s degree in business, Healthcare or related field. Equivalent combination of experience and/or education may substitute with a preference for at least five years progressive relevant work experience.
Minimum of three years’ experience in processing health insurance claims; including at least two years of Medicaid and Medicare claims experience.
Solid knowledge of managed care/health insurance claims including HCPC, CPT, and ICD10 coding for Medicaid and Medicare and commercial claims.
Thorough knowledge of claims processing including subrogation, reinsurance, appeals, etc.
Strong written and verbal communications skills.
Demonstrates support for the company’s mission, vision, and values.
Strong organizational, project and time management skills.
May be required to manage multiple priorities and projects with tight deadlines.
Ability to work independently and propose solutions to issues identified in daily operations.
Strong knowledge of computer applications and Microsoft Office.
A valid driver's license and proof of current auto insurance will be required for any position requiring driving

Nice To Haves

Previous supervisory experience preferred.

Responsibilities

Provides supervision and coordination of work performed by the claim research specialists.
Provides feedback, coaching and counseling regarding performance.
Responsible for maintaining quality assurance of all claim research activities.
Performs and evaluates the results of quality reviews and takes appropriate, timely action to resolve identified concerns.
Establishes and monitors workflows and inventory.
Makes appropriate adjustments based on work volume, projects and other changes that impact day to day operations.
Supervises the research of claims as well as special projects as requested with E-Plus.
Responsible for creation and oversight of claim research reports and dashboards for internal departmental monitoring, quality and reports due to the State or other contract holders.
Communicates key information within the department and to key stakeholders to ensure good coordination and effective operations.
Develops and maintains policies and procedures and maintains claim research correspondence and configuration within the claim research tracking tool.
Participates in performance and compliance audits conducted by the State or other contract holders.

Benefits

PTO
floating holidays
nine company paid holidays
a hybrid work environment
an Employee Assistance Program
a 401K
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Retirement plan
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).