Claims Support Supervisor
4 weeks ago
Job Title: Claims Support Supervisor FLSA: Exempt
Reports To: Chief Financial Officer Status: Full-time
Last Update: 4/9/2024 Next Review Date: 4/9/2026
Company Summary: Crossroads is an Arizona Department of Health Services licensed substance abuse treatment provider with proven expertise in serving men, women, and Veterans with Substance Use Disorder through the provision of high quality, successful, and affordable residential and outpatient recovery programs.
Due to federal contracts the following items are prohibited: Medical/Recreational marijuana, current parole, or probation. Initial: _______
Job Summary: The Claims Support Supervisor role oversees the billing team and serves as a liaison between plan members, health insurance companies, Crossroads’ billing/finance and programing departments to get claims issues resolved. The Claims Support handles all communication with health insurance carrier on the behalf of Crossroads, monitors eligibility and communicates with programming verification of benefits (VOB) outcomes and functions as a hub for matters related to billing and health plan relations.
Supervisory Responsibilities:
- Recruits, interviews, hires, and trains employees.
- Oversees the daily workflow of the site.
- Provides constructive and timely performance evaluations.
- Recommends compensation adjustments.
- Handles discipline and termination of employees in accordance with company policy.
- Involved with handling all employee relation issues.
- Timecard responsibilities.
- PTO management.
Essential Functions:
- Provide effective and timely customer service for members, providers, insurer and clients regarding health care claims.
- Ensure timely follow-up on requests for accounts to be reviewed.
- Resolves varies types of billing errors and discrepancies with insurance companies and clients.
- Responsible for processing credentialing for all providers within Crossroads.
- Contact providers, third party billers and insurance companies to resolve claim concerns.
- Oversees eligibility checks and documentation in Electronic Health Records (EHR).
- Analyze and identify trends and patterns related to charge report errors.
- Understand the evolving business requirements and adapt the operational processes to meet those requirements
- Support development of annual quality plans with service line/process owners.
- Understand and have knowledge of insurance contracts.
- Maintains and updates the current billing software rate schedule.
- Ensure all 835 and Electronic Fund Transfers (EFT’s) are set up properly.
- Audits billing software to ensure proper payment from insurance companies.
- Collaborates with peers and management across functions.
- Performs other duties, as needed.
Qualifications:
- CPR/First Aid/Narcan training
- Negative TB test, performed annually.
Knowledge, Skills, and Abilities:
- The ability to analyze and interpret medical record documentation and formulate appropriate clinical queries; as well as the ability to benchmark and analyze clinical documentation program performance.
- Demonstrated strong organizational skills and the ability to organize/prioritize tasks, multi-task, while working independently and effectively as part of a team.
- Exceptional critical thinking, communication, and clinical skills and the ability to maintain professional rapport with management, operations staff, clinicians, and other internal and external stakeholders.
Education & Experience:
- High school diploma or GED required; associates degree or higher preferred.
- 3-5 years’ experience in health insurance billing.
- A minimum of one year experience with Electronic Medical records System (EMS) and experience in quality assurance and management in a mental health setting.
- Computer/Microsoft Office expertise in addition to experience in reporting and analytics.
- Non-profit experience and a working knowledge of addiction and recovery preferred.
Work Environment:
- Fast paced behavioral health office setting.
- Primarily indoors, however, some outdoor work may be requested.
Physical Demands:
- While performing job duties, the employee is regularly required to sit and speak or hear. The employee is occasionally required to stand, walk, use hands to handle or feel, reach hands and arms, stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 50 pounds and seldom lift and/or move >100 pounds. Specific vision abilities required by this job include color vision, depth perception, and ability to adjust focus.
Shift Requirements:
- Days, nights, weekends, and holidays.
Travel:
- Valid AZ Driver’s License.
- May include travel between sites and other locations.
- Local and statewide travel when requested or required.
EEO:
- Crossroads is committed to providing a workplace free from harassment and discrimination. We believe all applicants and employees should be treated equally without regard to an individual’s race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors.
ADA Acknowledgement:
- To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions.
Benefits:
401(k) with matching of up to 3%
Company paid premiums for the full-time employee for Medical, Dental, Vision and Life Insurance
Supplemental Life Insurance and short term disability
Paid time off
Tuition Reimbursement
If you require alternative methods of application or screening, you must approach the employer directly to request this.
This posting will remain open until filled and/or for a minimum of 7 days.
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