Supervisor, Hospital Claims

2 weeks ago

New York, United States 1199 Seiu National Benefit Fund Full time
Responsibilities
  • Supervise the National Benefit Fund (NBF) Hospital Claims front-end Processor/clerical unit staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement
  • Provide support to the unit's Manager and Assistant Manager in optimizing workflows, distribution and review of work; response to audits, and monitoring of claims production/inventory
  • Ensure timely distribution and processing of claims through the Document Management System (DMS) and QNXT Pend Workflow, and of QNXT Call Tracking; resolve DMS-QNXT discrepancies
  • Ensure claims/correspondence are finalized in accordance with member benefit and eligibility parameters; Summary Plan Description provisions; Coordination of Benefits (COB) guidelines; regulatory and pre-authorization requirements; Claim Check and Medicare National Correct Coding Initiative (NCCI) rules; provider/repricing network contract terms and timeframes; and Fund/departmental policies
  • Monitor daily QNXT reports, work queue distribution/completion in the Document Management System (DMS), QNXT Pend Workflow, and QNXT Call Tracking systems
  • Review and assess staff member's performance with regard to quality/ productivity standards, audit results, and Health Insurance Portability and Accountability Act (HIPAA)/Compliance rules; provide audit rebuttal responses; meet regularly with staff to provide feedback/coaching; develop plans for additional training to remedy shortcomings; take correction action when necessary, to ensure the staff meet departmental/Fund requirements
  • Process high dollar claims at the Supervisor level; serve as back-up to Manager/Assistant Manager in their absence to ensure operational activities are achieved and projects are completed
  • Monitor timely workflow turnaround of documentation between the clerical staff and the Eligibility/COB and Provider Relations/Balance Billing Departments, to support claims finalization
  • Prepare weekly and monthly reports on unit inventory, activities, production, and progress
  • Prepare and maintain attendance/ lateness records and weekly timesheets for payroll to ensure compliance with Funds' policy and procedures
  • Coordinate testing of QNXT claims processing system in preparation of system enhancements/contract changes, and report/track issues
  • Perform special projects and assignment as assigned by management

Qualifications
  • Bachelor's Degree in Health Administration or equivalent years of work experience
  • Minimum of three (3) years' hospital claims processing or health claims Quality Control Reviewer/Auditor experience required; to include one (1) year leadership role required
  • Basic knowledge of basic Microsoft Word and Excel preferred
  • Strong knowledge of CPT, ICD-10, HCPCS, UB-04, hospital reimbursement methodologies and contracts
  • Knowledge of eligibility, medical terminology, third-party reimbursement; COB; basic Microsoft Word/Excel
  • Strong analytical, critical thinking, interpersonal and communication skills (written and oral)
  • Good leadership skills and ability to direct and motivate staff
  • Excellent organizational skills; able to multi-task, work well under pressure, prioritize and follow-up
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