Supervisor, Medical Claims

1 week ago

New York, United States 1199 Seiu National Benefit Fund Full time
Responsibilities
  • Partner with Manager to ensure the Medical Claims department and Fund goals are implemented, accurately communicated and achieved
  • Ensure Document Management System (DMS) claims inventory is monitored daily to achieve unit production goals, quality of work, maintains schedules and avoids delays in processing claims
  • Supervise Medical Claims staff in accordance with established departmental procedures, Human Resources guidelines, and provisions of the Collective Bargaining Agreement, as appropriate; monitor and process staff time and attendance via timekeeping system (ADP)
  • Assist staff with policy related questions and review complex cases, by providing guidance and direction during problem solving situations
  • Ensure staff is trained and developed to meet the goals and needs of the department; establish a collaborative team environment; coach Quality Control Reviewers, Processors and Clerks on resolving medical claims
  • Monitor and evaluate employee's overall performance and take corrective action as necessary; identify strengths, areas for development; create improvement plans, coach and counsel as appropriate
  • Ensure daily/weekly/monthly pend reports are acted on timely; provide management with daily DMS inventory receipt reports
  • Thoroughly monitor QNXT Call Tracking inquiries, QNXT Claim Troubleshooter, Medicare Secondary Payer (MSP) claims
  • Supervise Clerical Staff to ensure all tasks and functions are properly assigned and monitored
  • Perform additional duties and projects as assigned by management

Qualifications:
  • Bachelor's degree in Business Management, Health, or relevant years of experience required
  • Minimum three (3) years' experience as a Medical Claims Quality Control Reviewer or Auditor in a healthcare benefits environment; to include one (1) year experience in a leadership role required
  • In-depth knowledge of medical claims processing, medical terminology (MSP, CPT, ICD-10 and HCPCS codes), third-party reimbursement, and Coordination of Benefits (COB)
  • Intermediate skill level in Microsoft Word and Excel required; knowledge of PowerPoint and Access preferred
  • Good leadership skills and ability to direct and motivate staff; superb communication skills both verbal and written
  • Excellent critical thinking, attention to detail and problem-solving skills; able to work well independently and as a team player
  • Demonstrated organizational skills with ability to multi-task and meet operational deadlines
  • Ability to work well under pressure, maintain professional manner and presentation
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