Claims Supervisor
Curative
This job is no longer accepting applications
See open jobs at Curative.See open jobs similar to "Claims Supervisor" Soma Capital.Curative is searching for an experienced Claims Supervisor. This position successfully manages the day-to-day activities of the Claim Team.
Performs all duties below while maintaining compliance and confidentiality
and promoting the mission and philosophy of the organization.
ESSENTIAL DUTIES AND FUNCTIONS:
- Successfully manages the day-to-day operations of the Curative Claims Team
- Serves as a key point of contact for audits, claims payments, questions, and
customer service. - Ensure consistent training, auditing, and feedback is given to all staff.
- Consistently ensure the Claims Team meets/exceeds the following standards:
- Claims processing turn around.
- Procedural and financial accuracy
- Payment Cycle Review
- Manage the repricing process for non-par and OON claims in accordance with
turnaround time standards and client specifications. - Work closely with IT, Medical Services, System Support, to ensure efficiency.
- Work with Accounting, Executive and HR departments to define needed
processes. - Reviews High Dollar Claims for completeness and approves or denies payment
using established guidelines and making all required internal notifications. - Clearly and concisely documents claim adjudication decisions in Claim Notes.
- Works with the System Configuration department to ensure proper benefit
setup. - Completes required sample of professional and facility claims to audit for
accuracy, as required by the client. - Completes focused audits for error trends identified during processing or pre-
release audit. - Identify claim analyst training opportunities and provider billing issues.
- Submits audit results to the Claims Manager for review and final submission
to clients. - Acts as claims team resource for claims questions and benefit interpretation.
- Provides claim staff training via email alerts and training sessions.
- Reviews results of all prospective/retrospective audits provided from various sources to ensure that claims processing is handled, as mandated, by client directives.
- Analyzes, tracks and trends provider, system setup and claim errors.
- Works on claims team projects and reporting, assigned.
- Assists with all groups for professional and facility claim processing.
- Attend departmental training when required or requested.
- Adheres to the rules and regulations of Curative as described in the Employee Handbook and as defined in the unit/department/clinic procedures.
- Performs other duties and projects assigned.
MINIMUM QUALIFICATIONS:
Education:
● High school diploma or equivalent. Bachelor’s /Associate degree preferred.
Experience:
● At least 3-5 years of Claims Supervisor and/or Management experience required,
including HMO, PPO, ERISA, and government plans experience.
● Experience working with Health Edge- Health Rules Payer system, a variety of
claims payment systems, processing of all claim types, to include hospital/facility,
behavioral health, dental, vision, and professional medical claims. Experience
working with the VBA claims system. Customer Service experience preferred.
Knowledge, Skills, and Abilities:
● Ability to communicate with all levels of staff.
● Advanced Knowledge of claim coding and editing rules
● Knowledge of TDI regulations and requirements for claims payments
● Knowledge of HIPPA regulations
● Knowledge of medical terminology, IDC-10 CPT, and HCPCS coding.
● Proficient computer skills to include Microsoft Office applications.
● Excellent verbal and written communication skills
● Ability to communicate clearly and effectively.
● Ability to sit for extended periods of time at a computer workstation.
PHYSICAL DEMANDS:
SEDENTARY (requires lifting to 10 lbs., carrying small objects)
This job is no longer accepting applications
See open jobs at Curative.See open jobs similar to "Claims Supervisor" Soma Capital.