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 tasked with handling billing for healthcare services rendered to patients. This role involves enhancing and disseminating knowledge regarding products, benefits, quality standards, and organizational protocols. The supervisor ensures that claims are accurately processed in accordance with services provided, legislative mandates, and contractual agreements.

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

Key Responsibilities

  • Lead and motivate the Claims Team by providing daily guidance, support, coaching, and constructive feedback, while incorporating recognition and reward systems.
  • Oversee claim inventory and aging processes to effectively allocate daily workloads.
  • Recruit and manage personnel to maintain optimal staffing levels for consistent and high-quality processing.
  • Implement strategic resource planning to enhance productivity and turnaround times.
  • Stay informed about Federal and State regulations, as well as client specifications; enact necessary changes related to claims and billing practices.
  • Develop, update, and assess performance metrics to achieve quality, timeliness, service, and productivity objectives.
  • Offer expertise and general claims assistance to teams in the areas of reviewing, researching, investigating, negotiating, processing, and adjusting claims.
  • Identify and coordinate resources for claims reprocessing.
  • Analyze trends and generate comprehensive reports.
  • Conduct regular team meetings focused on performance enhancement, quality improvement, and documentation standards.
  • Facilitate training for new employees, ensuring 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 capacity within a healthcare claims processing environment, with familiarity in HIPPAA and HITECH standards, preferably in a healthcare TPA.
  • Experience with benefit administration platforms, such as Javelina, is preferred.
  • Understanding of Federal and State regulations governing the financial operations of healthcare services.
  • Familiarity with medical terminology and Diagnosis Codes (ICD-9 & ICD-10).
  • Ability to analyze and resolve issues related to data collection, billing, and coding; identify root causes and implement solutions.
  • Proficient in performing complex calculations related to claims processing.
  • Strong working knowledge of standard office software, including MS Word, Excel, Outlook, and PowerPoint.
  • Expertise in computer usage, including advanced keyboard skills and the ability to learn new software applications.
  • Excellent communication skills, both verbal and written, with the ability to interact professionally with internal and external stakeholders.
  • Ability to work collaboratively within a team to achieve shared objectives, while empowering colleagues to take ownership of their responsibilities.
  • Detail-oriented with a strong focus on accuracy and quality in all tasks.
  • Sound judgment in decision-making, utilizing available resources effectively.
  • Commitment to maintaining confidentiality and discretion.
  • Proactive in identifying and resolving issues in a timely manner, with strong analytical skills.
  • Skilled in coaching and mentoring team members through effective communication and follow-up.
  • Open-minded and willing to consider new ideas and approaches.
  • Ability to prioritize tasks and manage time efficiently.
  • Adaptable to changes in the work environment and capable of handling competing demands.
  • Consistently follows instructions and seeks feedback for improvement.
  • Builds 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 functions.

  • Constant: Communicate verbally, listen, and use hands and fingers for computer and telephone operations; occasional movement within the office.
  • Constant: Close vision is required for 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 employee will primarily be seated during the work shift.

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 setting is indoors in a climate-controlled office, with a noise level that ranges from low to moderate.

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