Claims Supervisor

Claims Supervisor will be responsible for assisting Claims Manager in overseeing the Claims Department.

Responsibilities include, but not limited to:

•   Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including:

       Contractual agreement rates

       Health Plan procedures

       Medicare and Medi-cal reimbursement

       Claims processing guidelines

• Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, process, and adjusting claims
• Authorizes the appropriate payment or refer claims for further review
• Respond and resolve providers’ and health plans’ inquires in a timely manner
• Provide support to Configuration to ensure accuracy
• Coordinate with Compliance department to process claims accordingly to Health Plan requirements.
• Support Compliance department in Health Plan audits
• Help identify issues from audit findings and develop action plans to resolve
• Supervise and monitor Claims staff production and guide them for improvements
• Provide additional training to Claims staff for efficient processing as needed
• Ensure check runs are ready according to schedule
• Attend meetings as required
• Report to Claims Manager
• Other duties as needed

Qualifications:

• Bachelor’s degree in related field
• Minimum of one year in a managerial position
• Must have at least 5 years of applicable healthcare claims adjudication experience within a managed care industry
• Must be familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing.
• Must be familiar with facility (UB-04) and professional (CMS-1500) claim billing practices.
• Must have good written and communication skills.
• Must have managerial and risk management skills
• Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment.
• Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. 
• Typing skills of at least 40 wpm.