Healthcare Claims Team Leader

2 weeks ago

Tampa, Florida, United States Leading Edge Full time
Job Overview

Position Summary:
The Claims Processing Supervisor is responsible for managing the daily operations of the team that handles the billing for healthcare services rendered to patients. This role involves cultivating and disseminating knowledge regarding products, benefits, quality standards, and organizational protocols. The supervisor ensures that claims are processed accurately in accordance with services provided, legal requirements, and plan agreements. This position also entails coordinating efforts both internally and externally by providing necessary information and reporting.

This role is primarily office-based, with potential for some remote work following the completion of onboarding and training.

Key Responsibilities

  • Lead and manage the performance of the Claims Team by offering daily guidance, support, coaching, and constructive feedback, while incorporating recognition and reward systems.
  • Oversee inventory levels and the aging of claims to effectively allocate daily workloads.
  • Recruit and manage staffing to ensure consistent and high-quality processing.
  • Conduct resource planning to optimize productivity and turnaround times.
  • Stay informed about Federal and State regulations as well as client requirements; implement necessary changes related to claims and billing standards.
  • Develop, update, and monitor performance metrics to achieve quality, timeliness, service, and productivity objectives.
  • Provide expert claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims.
  • Identify and coordinate resources for rework as needed.
  • Analyze trends and generate comprehensive reports.
  • Facilitate regular meetings with staff to enhance performance, quality, and documentation.
  • Conduct training sessions for new hires to ensure they meet required performance metrics.

Qualifications

  • Associate degree in a relevant field such as business administration, accounting, finance, or equivalent experience.
  • A minimum of 3 years in a supervisory position within a healthcare claims processing environment, with knowledge of HIPPAA and HITECH standards, preferably in a healthcare TPA.
  • Familiarity with benefit administration platforms, such as Javelina, is preferred.
  • Understanding of Federal and State regulations concerning fiscal operations in healthcare services.
  • Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10).
  • Ability to analyze and interpret issues related to data collection, billing, and coding, and apply effective solutions.
  • Proficient in performing complex calculations related to claims.
  • Strong working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint.
  • Excellent communication skills for interacting with internal and external stakeholders.
  • Ability to work collaboratively as part of a team to achieve shared goals.
  • Detail-oriented with a strong emphasis on accuracy and thoroughness.
  • Demonstrated ability to prioritize tasks and manage time efficiently.
  • Adaptable to changes in the work environment and capable of handling competing demands.
  • Exhibit trustworthiness and professionalism in all interactions.

Physical Requirements
The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodations can be made to enable individuals with disabilities to perform these functions.

  • Constantly required to talk, hear, and use hands and fingers to operate a computer and telephone.
  • Specific vision abilities required include close vision for computer work.
  • Occasionally required to lift and/or move up to 10 pounds.
  • Regular, predictable attendance is necessary.
  • Regularly required to sit for extended periods.

Work Environment
The work environment described is representative of what must be met by an employee to successfully perform the essential functions of this job.

  • The work environment is indoors in a controlled climate, office setting with a low to moderate noise level.

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