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Medical Claims Supervisor

Cornerstone Staffing, Inc. Omaha, NE
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Job Description

Job Description

Purpose of the Job:

The overall purpose of this job is to manage the Claims Processing function for PACE Pathways including direct supervision of the claims processors. Performs complex and technical analysis for research, resolution, and recovery for PACE Pathways healthcare/insurance claims management. The Claims Supervisor works to plan, organize, and direct the activities of the medical claims department. This position will also coordinate claims processing as needed with representatives of other departments. Supports and lives out Immanuel’s Mission and CHRIST Promises.

  • KEY RESPONSIBILITIES

Key Areas

Key Responsibilities and Duties of the Job

Claims Management

  • Management of the Claims Processing function for PACE Pathways including supervising the work of claims processors.
  • Performs various technical analyses and research for resolution and recovery for PACE Pathways healthcare/insurance claims management.
  • Oversees the configuration of claims management systems and ensuring the correctness of said configurations.
  • Provides training for new employees on claims management processes, systems, policies, procedures and expectations.
  • Provides technical assistance and coaching to staff to ensure proper, timely handling of claims of all service and provider types.
  • Stays up-to-date on pertinent Federal and State laws and regulations, and implementing mandated changes regarding claims and billing requirements.
  • Assists with the resolution of provider inquiries, complaints, disputes and appeals.
  • Supports monthly Incurred but Not Received (IBNR) and Re-Insurance reporting in conjunction with Finance.

Quality/Systems Management

  • Monitors claims processing activities, production standards and quality of results; this includes select reviews of specific claims processing activities for quality assurance and time to process.
  • Develops and maintains claims management policies and procedures.
  • Maintains the processes and systems used to monitor and assess the performance of claims management staff and systems.
  • Continuously works at identifying, assessing and implementing process and system improvements specific to claims management; this may include interacting with other departments such as Provider Contracting, Information Systems, Finance, Risk Adjustment, and Pathways Center Operations.

Staff Management

  • Provides line management to direct reports including; setting performance targets, monitoring performance, and providing development opportunities.
  • Ensures workloads are balanced and that resources are being used effectively; adjust resources to meet business needs as necessary.

Other

  • Assists with special project assignments.
  • Performs other duties as assigned or requested.
  • QUALIFICATIONS

Education-

  • Bachelor’s Degree in Finance/Accounting, Business, or a related field is preferred.
  • Equivalent years of experience may substitute for education requirement.

Experience-

  • Four (4) years of experience in medical claims processing, AP/AR, medical clinic billing or related experience is required. Experience in a health care or hospital setting is desirable.
  • Two (2) years of supervisory/management experience with increasing responsibility.
  • Equivalent years of education may substitute for experience requirement.

Other Requirements –

  • American Academy of Professional Coders (AAPC) Certified Professional Coder is preferred.

KSA- Knowledge Skills and Abilities-

  • Strong knowledge of Federal, State, and County laws and regulations related to healthcare claims management.
  • Strong knowledge of basic medical terminology with particular focus on healthcare coding and/or certification in healthcare terminology e.g. AAPC Certified Professional Coder.
  • Knowledge of Medicare and Medicaid programs, payment and organization.
  • Ability to analyze and interpret problems in data collection.
  • Knowledge of medical/clinical structure and operations.
  • Skilled in data and information management.
  • Strong mathematical skills with attention to detail and accuracy.
  • Strong knowledge of billing and accounts receivable.
  • Ability to manage multiple priorities.
  • Ability to utilize critical thinking, analytical, and problem solving skills.
  • Strong computer skills in Microsoft Office, including Excel, Word and Outlook and the ability to learn and use various software programs.
  • Ability to work independently, meet deadlines, and multi-task while maintaining quality standards.
  • Ability to develop specific goals and plans to prioritize, organize, and accomplish job duties.
  • Excellent customer service skills.
  • Ability and willingness to work in a team environment.
  • Ability to communicate effectively both verbally and in writing with individuals at all levels in the organization.
  • Ability to communicate with external business contacts in an articulate, professional manner while maintaining the necessary degree of confidentially.
  • Ability to establish, implement, and measure goals that are linked to the department or organization.
  • Strong ethical leadership skills including demonstrating personal accountability and responsibility.
  • Skills in managing and supervising staff members.

Job Type: Full-time

Salary: $55,000.00 to $65,000.00 /year

Job Details

Date Posted December 17, 2018
Date Closes January 31, 2019
Located In Omaha, NE
Job Type Full-time Employee
Compensation Salary, $55,000.00 - $65,000.00
Experience Level Intermediate (3-7 yrs. experience)
SOC Category 31-9099.00 Healthcare Support Workers, All Other
Zipcode 68144
Name Nick Moyer
Address 13934 GOLD CIRCLE
City, State and Zip Omaha, NE 68144
Phone 402-896-9191 x 125
FAX 402-614-1374

This job offers the following benefits

  • 401(k) Retirement Savings Plan
  • Dental
  • Life Insurance
  • Medical

This job requires the following skills

  • Administrative Assistant
  • Clerical
  • Customer Service
  • Data Entry
  • Billing / Invoicing
  • Insurance Claims Processing - Medicare Supplement
  • Medical Claims Processing
  • Documentation Management
At a Glance
Enjoy these benefits
  • 401(k) Retirement Savings Plan
  • Dental
  • Life Insurance
  • Medical
Location