Medical Claims Supervisor

6 days ago


Richfield, Minnesota, United States Lifeworks Services Full time
Medical Claims Supervisor Job Description

Lifeworks Services is seeking a highly skilled Medical Claims Supervisor to oversee the day-to-day operations of our claims processing functions. As a key member of our finance team, you will be responsible for ensuring the timely and accurate adjudication, processing, and payment of claims or claims adjustments.

Key Responsibilities:
  • Supervise and coordinate the medical claims / Medicaid billing, collections, and customer accounts in compliance with GAAP, government and private contracts, and HIPAA.
  • Select, supervise, develop, motivate, and retain accounts receivable and billing staff.
  • Participate in and support system and state mandated changes while maintaining days sales outstanding to 30 days or less.
  • Point of contact for analyzing and researching why specific customer accounts remain unpaid, working across program teams to resolve problematic claims.
  • Validate claims data by conducting regular internal audits to ensure overall timely and accurate adjudication, processing, and payment of claims or claims adjustments.
  • Ensure proper segregation of duties and overall compliance with insurance and/or government contracts.
  • Participate in system changes or upgrades as a subject matter expert regarding the medical claims processing functions and suggest necessary improvements for compliance to provider requirements, efficient processing, and accuracy in claims processing.
  • Maintain current understanding of medical claims processing as it relates to medical billing including Medicaid service regulatory changes, insurance contracts, and overall medical billing practices.
  • Work collaboratively with program services, IT, Compliance, HR, and Payroll, providing excellent customer service, improving processes and the delivery of projects and initiatives.
  • Make recommendations with regards to the billing function, the work, and the team.
  • Contribute to the organization's mission by complying with Lifeworks policies and procedures, using resources wisely.
  • Follow safety procedures and assist in identifying safety needs for self and others.
Requirements:
  • Strong analytical and problem-solving skills.
  • Experience with medical claim management and medical billing software systems.
  • Demonstrated leadership and staff development skills and ability to establish and cultivate strong relationships.
  • Ability to understand and communicate written and verbal directions.
  • Regular attendance, reliability, and punctuality is necessary to meet the needs of the business.
  • Well-organized with excellent attention to detail.
  • Aptitude to work independently with excellent time management skills.
  • Experience working effectively with others to reach common goals and objectives.
  • Skilled at establishing and cultivating strong relationships.
  • Ability to take initiative and strengthen relationships with current and new community.

Lifeworks Services offers a comprehensive benefits package, including 18 days of PTO accrued in the first year of employment, 11 paid holidays, medical, dental, vision, life, AD&D insurance, short & long-term disability coverage, Health Savings Account (HSA), Flexible Savings Account (FSA), and prescription drug coverage. We also offer up to $3,000 annually in tuition reimbursement and a 403(b) retirement plan with a 3% company match.


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