Healthcare Claims Supervisor

Job Summary:

The Claims Supervisor oversees the daily activities of 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 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 manage the performance of the Claims Team by providing daily leadership and support, coaching, feedback, and direction, incorporating positive feedback and reward mechanisms
• Monitor inventory levels and aging of claims and queues 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 as well as client requirements; implement changes regarding claims and billing standards
• Develop, revise, and monitor metrics to meet quality, time, service and productivity goals
• Provide expertise and 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 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; Bachelor level degree preferred
• 3 years of experience in a supervisory role in a healthcare claims processing setting where HIPPAA and HITECH standards are utilized, preferably in a healthcare TPA
• 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
• Solid working knowledge of standard computer applications including MS Word, Excel Outlook, and PowerPoint
• Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
• Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyzes information skillfully
• Teach, coach, and counsel associates by effectively communicating and providing follow-up.
• Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers

Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus
• Occasional: Lift and/or move up to 10 pounds
• Constant: Regular, predictable attendance in the office is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending.

Work Environment - The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.