This role is on-site and has responsibility for at least 10 direct reports.
Benefits claims processing experience is a must; TPA experience is a plus.
The Claims Supervisor oversees the daily activities for 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 for 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.
Duties and Responsibilities:
- Effectively mange the performance of the Claims Team by providing daily leadership and support and provide coaching, feedback, support and direction; incorporating positive feedback and reward mechanisms.
- Monitor inventory levels and aging of claims 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; implement changes regarding claims and billing requirements.
- Develop, revise and monitor metrics in order to meet division quality, time service and productivity goals.
- Provide expertise or 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.
Required Knowledge, Skills and Abilities:
- Associate’s 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 role where HIPPAA and HITECH standards are utilized.
- 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.