Healthcare Claims Supervisor

2 weeks ago

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

Position Summary:
The Claims Manager at Leading Edge plays a pivotal role in overseeing the team dedicated to managing 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 processed accurately in accordance with services provided, legal stipulations, and plan agreements. This role involves coordinating efforts both internally and externally by supplying necessary information and generating reports.

Key Responsibilities:

  • Lead and direct 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 staffing levels to guarantee ongoing, high-quality processing.
  • Implement effective resource planning to enhance productivity and turnaround times.
  • Stay informed on Federal and State regulations; execute necessary changes related to claims and billing requirements.
  • Develop, update, and track metrics to achieve departmental quality, service timing, and productivity objectives.
  • Monitor claims inventory and aging, assisting with workflow assignments as needed.
  • Provide expert support to teams in the areas of reviewing, researching, investigating, negotiating, processing, and adjusting claims.
  • Identify and coordinate resources for reprocessing claims.
  • Analyze trends and deliver 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, adhering to HIPPAA and HITECH standards.
  • Familiarity with benefit administration platforms, such as Javelina, is preferred.
  • Understanding of Federal and State regulations concerning the financial operations of healthcare services.
  • Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10).
  • Proficient in analyzing and interpreting issues related to data collection, billing, and coding, with the ability to identify the root cause and implement solutions.
  • Capable of performing complex calculations related to claims processing.
  • Strong proficiency in standard computer applications, including MS Word, Excel, Outlook, and PowerPoint.
  • Excellent communication skills, both verbal and written, with the ability to engage professionally with internal and external stakeholders.
  • Ability to work collaboratively within a team to achieve common goals, fostering a supportive environment.
  • Detail-oriented with a commitment to quality in all aspects of work.
  • Proficient in decision-making using available resources and sound judgment.
  • Ability to maintain confidentiality and exercise discretion.
  • Skilled in problem identification and resolution in a timely manner.
  • Experience in mentoring and coaching team members through effective communication and follow-up.
  • Open-minded and willing to embrace new ideas and approaches.
  • Demonstrates accuracy and thoroughness; actively monitors work to ensure quality.
  • Effective in prioritizing and planning work activities to optimize time management.
  • Adaptable to changes in the work environment, managing competing demands and unexpected events.
  • Follows instructions and seeks feedback for continuous improvement.
  • Acts in a manner that builds trust with management, colleagues, and clients.

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

  • Constant: Engage in verbal communication, auditory processing, and utilize hands and fingers for computer and telephone operations; occasional movement within the office.
  • Constant: Close vision is necessary due to extensive computer work.
  • Occasional: Ability to lift and/or move up to 10 pounds.
  • Constant: Regular and predictable attendance is essential.
  • Constant: The employee will primarily be seated during the work shift.

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 environment is indoors within a controlled climate office setting, 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 of the abilities required to perform the job. This description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

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