Claims Management Supervisor

2 weeks ago

Dallas, Texas, United States SCP Health Full time


Join SCP Health and make a meaningful impact

At SCP Health, your contributions are valued. We are dedicated to connecting healthcare facilities with skilled professionals to enhance clinical outcomes. With a vast network serving over 8 million patients, 7500 providers, and 400 healthcare facilities across 30 states, SCP Health excels in clinical practice management throughout the entire healthcare spectrum, including emergency services, hospital care, wellness initiatives, telehealth, intensive care, and outpatient services.

What makes SCP Health a great place to work:
  • A vibrant culture within Revenue Cycle Services that prioritizes people, processes, and technology.
  • Flexible work schedules.
  • A proven history of promoting a healthy work/life balance.
  • Comprehensive benefits and competitive salary packages.
  • A commitment to nurturing an inclusive environment based on our core values: collaboration, courage, agility, and respect.
  • Key responsibilities include:
As a Claims Management Supervisor, you will lead a team of accounts receivable specialists to optimize productivity and meet financial targets. This role involves overseeing daily operations, maintaining workflow efficiency, conducting quality audits, and ensuring adherence to established policies and procedures. Your expertise will be crucial in resolving complex issues and serving as the primary liaison for the department manager. The Supervisor plays a pivotal role in enhancing the overall performance and proficiency of the claims unit, which is vital for the success of SCP Health.
  • Act as the main point of contact for claim denials related to Provider Enrollment, collaborating with various departments.
  • Perform essential supervisory functions, including recruitment, performance evaluations, conflict resolution, and payroll management.
  • Monitor team performance, encouraging goal achievement while ensuring adequate staffing.
  • Establish clear expectations and hold team members accountable.
  • Review daily Accounts Receivable by payer for denial follow-up and conduct quality audits to enhance revenue performance.
  • Identify and address insurance claim denials.
  • Manage escalated denial issues requiring advanced expertise and undertake complex projects as assigned.
  • Oversee cross-functional workflows related to credentialing and patient contact.
  • Maintain high levels of productivity and quality in work output.
  • Provide guidance to team members in resolving payer-related disputes.
  • Analyze denial trends and collaborate with the team to implement proactive strategies.
  • Offer constructive feedback to improve claims submission accuracy and completeness.
  • Generate and distribute standard and special reports as needed.
  • Assess staff development needs and recommend training materials based on audit findings.
  • Assist in developing and implementing departmental policies and procedures.
  • Ensure compliance with HIPAA regulations.
  • Keep upper management informed of both achievements and areas for improvement.
  • Identify opportunities for enhancing reimbursement and billing systems.
  • Provide regular insights to management based on research and payer behavior trends.
  • Collaborate with various departments to ensure revenue integrity.
  • Participate in management meetings related to Provider Enrollment as directed.
  • Stay updated on changes to payer requirements and communicate necessary adjustments to management.
  • Perform any additional duties as assigned by management.
Qualifications:

High School Diploma required.
  • Completion of 2 years of college preferred or 3-5 years of experience in medical collections or provider enrollment.
  • Ability to manage multiple priorities effectively.
  • In-depth understanding of the revenue cycle process and account adjudication.
  • Familiarity with Payor Credentialing processes, both Participating and Non-Participating.
  • Knowledge of Provider Credentials and CMS Regulations.
  • Ability to manage stress effectively.
  • Proficient in software applications with a focus on integrating technology into operations.
  • Strong organizational skills.
  • Ability to cultivate a cooperative and respectful workplace.
  • Excellent interpersonal and communication skills, capable of engaging with diverse groups.
  • Familiarity with web access and utilization.
  • Effective oral and written communication skills.
  • Experience with Credential Stream Software or similar credentialing/enrollment systems.
SCP Health and its affiliated companies require applicants for specific positions to be vaccinated against COVID-19 as a condition of employment, where applicable. We will consider accommodation requests as required by law.

To learn more about SCP Health, please visit our website.

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