Claims Customer Service Supervisor

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Claims Supervisor position focuses on the effective processing of all delegated Medicare claims, will work in a deadline-oriented environment as part of a growing operations team. Have a solid working knowledge of ICD-9, CPT, HCPCS, HCFA1500, UB92’s, RBRVS, and RVS. Effectively works with all levels of staff and management.

Position Duties & Responsibilities

• Provide management support in reviewing, researching, scanning, archiving, statusing, and verifying eligibility of claims.
• Oversee the preparation of medical records for scanning and routing to appropriate departments
• Analyze data, identify trends and design/provide reports as necessary.
• Communicate, collaborate and research claims inquiries or issues as they arise, applying appropriate knowledge and experience.
• Apply knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly according to HIPAA, state specific regulations and grievance procedures.
• Apply the respective and timely scanning and submitting of claims for data entry.
• Use appropriate documentation, reference materials and/or websites to ensure that claims are processed accurately and efficiently.
• Monitor inbound provider calls to ensure accurate information is shared in a timely and professional manner.
• Respectfully and supportively collaborate with business partners to help address issues related to the Claims Customer Service area.
• Identify, develop and implement new processes procedures and solutions as needed.
• Identify and communicate opportunities to improve claims processing efficiency and reduce rework.
• Track, trend, and communicate claim errors with leadership along with training recommendations.
• Supervise, monitor, track and direct day to day operations staff.
• Oversee annual internal reviews and audits of claims operations as part of an ongoing quality control process.
• Develops staff through performance management, goal setting, training, and effective employee relations and retention efforts.
• Ensure that departmental standards and timelines are met within each unit.
• Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
• Supervise daily activities of claim examiners, workflow, production, pended claims, and audits.
• Makes recommendations for process improvement as needs are identified.
• Perform other duties as assigned.
  
  

Education, Training And Experience

• Minimum of 5 years Supervisory experience in Manage Care Claims and minimum of 5 years’ experience with health care claims adjudication.
• Knowledge of claims life cycle, medical terminology, ICD-9, CPT, HCPCS, HCFA1500, UB92’s, RBRVS, RVS and Coordination of Benefits (COB).
• Thorough understanding of claims operations to include payment of claims, interpretation of contracts; communication of benefits and eligibility.
• Ability to draw upon knowledge and experience to anticipate issues, potential risks, implications, and changes to Medicare.
• Strong math and analytical skills, including the ability to analyze and organize data.
• Excellent ability to build and maintain business relationships with providers by providing prompt and accurate service.
• Strong attention to detail.
• Proficiency in Microsoft Office products, including Power Point, Word, and Excel.
• Proven ability to lead team members in a positive and productive manner.
• Demonstrated strong organizational, analytical, oral presentation, written communications, decision-making skills and leadership skills.
• Must be able to work under general guidance of Claims Manager with little direct supervision.
• This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period.*