What are the responsibilities and job description for the Appeals Supervisor position at CodeMax Behavioral Health Billing?
Reports to: Director of RCM
Employment Status: Full-Time
FLSA Status: Exempt
Location: Fort Lauderdale, FL
Job Summary:
The Appeals Supervisor oversees our team managing payor contracts, negotiations, and renegotiations. This leadership position extends beyond the responsibilities of an Appeals Specialist, focusing on guiding the team responsible for handling appeals and grievances functions, and ensuring timely and effective management of payor contracts. The supervisor will play a crucial role in resolving assigned cases, documenting case actions accurately, and supervising the team engaged in appeals and grievances. The position demands a deep understanding of Managed Care in both Provider and Payor settings, as well as expertise in Payor Contracting tasks within the substance abuse and behavioral health field.
Duties/Responsibilities:
Employment Status: Full-Time
FLSA Status: Exempt
Location: Fort Lauderdale, FL
Job Summary:
The Appeals Supervisor oversees our team managing payor contracts, negotiations, and renegotiations. This leadership position extends beyond the responsibilities of an Appeals Specialist, focusing on guiding the team responsible for handling appeals and grievances functions, and ensuring timely and effective management of payor contracts. The supervisor will play a crucial role in resolving assigned cases, documenting case actions accurately, and supervising the team engaged in appeals and grievances. The position demands a deep understanding of Managed Care in both Provider and Payor settings, as well as expertise in Payor Contracting tasks within the substance abuse and behavioral health field.
Duties/Responsibilities:
- Leads negotiations for payment terms and rates for new and existing contracts, ensuring favorable conditions for the organization.
- Reviews contract terms and conditions for accurate implementation and oversees this process within the team.
- Manages all Payors and markets or assigned geographic areas.
- Monitors and renegotiate contract renewals, maintaining productive relationships with Payor Negotiators and Representatives.
- Resolves escalated contract-specific issues and supervises special projects.
- Assists with analysis of payor mix and rate structure and identifies contract issues impacting revenue.
- Maintains and works to increase the team's knowledge of billing databases for reporting.
- Provides leadership, training, and support to the team handling appeals and grievances.
- Develop strategies to improve contract negotiation processes and outcomes.
- Manages resources, schedules, and performance evaluations for the team.
- All other duties as assigned.
- Proficient in managing multiple tasks simultaneously and meeting sensitive deadlines.
- Skilled in the development, coordination, and analysis of payor contracts.
- Excellent organizational, communication, and problem-solving skills.
- Proficient with Microsoft Office applications.
- Leadership and team management abilities.
- Ability to work collaboratively and flexibly with other organizational areas.
- Bachelor’s degree or equivalent work experience preferred.
- A minimum of 5 years of experience in a health plan operations setting, preferably in Appeals and Grievances, Provider Disputes, Claims, or Managed Care.
- Experience in claim pricing methodologies and certified claim coding is preferred.
- A minimum of 5 years of managed care experience with contracting, revenue cycle management, and rate analytics.
- Comprehensive knowledge of policies, regulations, and guidelines in the managed care environment.
- Experience with commercial payment methodologies and claims processing systems.
- Health Insurance
- Vision Insurance
- Dental Insurance
- 401(k) plan with matching contributions
