Healthcare Claims Supervisor

2 weeks ago

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

Position Summary:
The Claims Manager plays a pivotal role in leading the team tasked with overseeing the billing processes for healthcare services rendered to patients. This position is responsible for cultivating and disseminating knowledge regarding products, benefits, quality standards, and organizational protocols. The Claims Manager ensures that claims are accurately approved or denied based on the services provided, compliance with legislative mandates, and adherence to plan agreements. This role also involves coordinating efforts both internally and externally by supplying essential information and generating reports.

Key Responsibilities:

  • Oversee and guide the claims processing operations for clients, ensuring that performance metrics are consistently met or surpassed, while integrating positive feedback and reward systems.
  • Recruit and manage personnel levels to guarantee ongoing, high-quality processing.
  • Implement effective resource planning to enhance productivity and turnaround times.
  • Stay informed about Federal and State regulations; enact necessary adjustments concerning claims and billing requirements.
  • Develop, update, and track metrics to achieve departmental quality, timeliness, and productivity objectives.
  • Monitor claims inventory and aging, assisting with workflow distribution.
  • Provide specialized support to teams in reviewing, researching, negotiating, processing, and adjusting claims.
  • Identify and coordinate resources for reprocessing as needed.
  • Analyze trends and generate comprehensive reports.

Qualifications:

  • Bachelor's degree in a relevant field such as business administration, accounting, finance, or equivalent experience.
  • A minimum of 4 years in a supervisory capacity within a healthcare claims processing environment, with knowledge of HIPPAA and HITECH standards.
  • Familiarity with benefit administration platforms, preferably Javelina.
  • Understanding of Federal and State regulations related to the financial operations of healthcare services.
  • Proficient in medical terminology and Diagnosis Codes (ICD-9 & ICD-10).
  • Ability to analyze and interpret issues in data collection, billing, and coding, identifying root causes and implementing solutions.
  • Capable of performing complex calculations related to claims processing.
  • Strong proficiency in standard office software including MS Word, Excel, Outlook, and PowerPoint.
  • Excellent communication skills for effective interaction with internal and external stakeholders.
  • Collaborative team player, fostering a supportive environment to achieve common goals.
  • Detail-oriented with a commitment to quality in all job aspects.
  • Demonstrated ability to make informed decisions using available resources.
  • Maintain confidentiality and exercise discretion in all matters.
  • Proficient in problem-solving, with the ability to gather and analyze information effectively.
  • Experience in mentoring and coaching team members through effective communication.
  • Open-minded and willing to explore new ideas and approaches.
  • Exhibit accuracy and thoroughness in work, monitoring for quality.
  • Prioritize tasks efficiently and adapt to changing work environments.
  • Follow instructions and respond positively to feedback for continuous improvement.
  • Build trust with management, colleagues, and clients through integrity and professionalism.

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

  • Constant: Engage in verbal communication, auditory processing, and utilize hands and fingers for computer and telephone operations; occasional mobility within the office.
  • Constant: Close vision required for extensive computer work throughout the shift.
  • Occasional: Ability to lift and/or move up to 10 pounds.
  • Constant: Regular and predictable attendance is essential.
  • Constant: The role typically involves prolonged periods of sitting.

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

  • The physical setting is indoors within a controlled climate office environment, with a noise level that may range from low to moderate.
The responsibilities outlined are representative but not exhaustive of tasks that may be assigned or required for this position. This description is subject to change at any time, and other related duties may be assigned. This description does not alter the at-will status of employment.

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