12/05/2022

Clams Supervisor On Site

  • NTT DATA
  • Tampa, FL, United States

Job Description

Claims Supervisor


Job Summary:
The Claims Supervisor oversees the daily activities for the team responsible for processing the billing for healthcare services provided to patients. This role will develop and share knowledge of products, benefits, quality requirements and organization procedures. This position ensures claims are for allowed or denied based on actual services rendered, legislative requirement and plan agreements. This position will coordinate both internally and externally by providing information and reporting.

Duties and Responsibilities

Effectively manage the performance of the Claims Team by providing daily leadership and support and provide coaching, feedback, support, and direction, incorporating positive feedback and reward mechanisms
Monitor inventory levels and aging of claims to assign work daily.
Hire and manage staffing levels to ensure continuous, quality processing
Conduct effective resource planning to maximize productivity and turn-around time
Follow and maintain knowledge of Federal and State regulations; implement changes regarding claims and billing requirements
Develop, revise, and monitor metrics to meet quality, time, service and productivity goals
Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims
Identify and coordinate resources for re-work
Analyze and identify trends and provide robust reports
Conduct regular meetings with staff toward improving performance, quality and documentation.
Conduct training for new hires and ensure the ramp-up to required metrics is on track.


Required Knowledge, Skills and Abilities
Associate degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience
3+ years of experience in a supervisory role in a healthcare claims processing setting where HIPPAA and HITECH standards are utilized, preferably in a healthcare TPA
Experience with benefit administration platforms such as Javelina preferred
Knowledge of Federal and State codes related to fiscal operations of healthcare services
Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10)
Ability to analyze and interpret problems in data collection, billing, and coding. Determine the source of the problem and apply a solution
Must be able to calculate and re-calculate claims, performing (sometimes complicated) calculations, applying formulas using multiplication and percentage
Solid working knowledge of standard computer applications including MS Word, Excel Outlook, and PowerPoint
Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
Communicate clearly and professionally with internal and external customers
Work effectively as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
Pay close attention to detail in all aspects of the job
Make decisions using available resources and sound judgment
Maintain confidentiality and discretion
Identify and resolve problems in a timely manner, gather and analyzes information skillfully
Teach, coach, and counsel associates by effectively communicating and providing follow-up.
Open to other's ideas and exhibits a willingness to try new things.
Demonstrate accuracy and thoroughness; monitor work to ensure quality.
Prioritize and plan work activities to use time efficiently.
Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
Follows instructions, responds to direction, and solicits feedback to improve.
Act in such a way to instill trust from management, other associates, as well as customers

Physical Demands:
The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
Occasional: Lift and/or move up to 10 pounds
Constant: Regular, predictable attendance is required
Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
Work Environment:
The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.

The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.
NEEDS ASSESSMENT
Date: 11/7/2022

CLIENT NAME: Leading Edge Administrators

CONTRACT AGREEMENT? Agree verbally on direct hire percentage

NEED (Temp, TTH or Direct hire): Direct hire
REASON FOR NEED: Bandwidth Projected growth into 2023

SKILL Positions' General Duties and Tasks:
Supervisor of Claims Operations (Healthcare)
SKILLSET REQUIREMENTS: Knowledge, Skills and Abilities (KSAs)

Duties and Responsibilities
Competencies:
The Claims Supervisor oversees the daily activities for the team responsible for processing the billing for healthcare services provided to patients. This role will develop and share knowledge of products, benefits, quality requirements and organization procedures. This position ensures claims are for allowed or denied based on actual services rendered, legislative requirement and plan agreements. This position will coordinate both internally and externally by providing information and reporting .

Duties and Responsibilities
  • Effectively manage the performance of the Claims Team by providing daily leadership and support and provide coaching, feedback, support, and direction, incorporating positive feedback and reward mechanisms
  • Monitor inventory levels and aging of claims to assign work daily.
  • Hire and manage staffing levels to ensure continuous, quality processing
  • Conduct effective resource planning to maximize productivity and turn-around time
  • Follow and maintain knowledge of Federal and State regulations; implement changes regarding claims and billing requirements
  • Develop, revise, and monitor metrics to meet quality, time, service and productivity goals
  • Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims
  • Identify and coordinate resources for re-work
  • Analyze and identify trends and provide robust reports
  • Conduct regular meetings with staff toward improving performance, quality and documentation.
  • Conduct training for new hires and ensure the ramp-up to required metrics is on track.


Required Knowledge, Skills and Abilities
  • Associate degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience
  • 3+ years of experience in a supervisory role in a healthcare claims processing setting where HIPPAA and HITECH standards are utilized, preferably in a healthcare TPA
  • Experience with benefit administration platforms such as Javelina preferred
  • Knowledge of Federal and State codes related to fiscal operations of healthcare services
  • Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10)
  • Ability to analyze and interpret problems in data collection, billing, and coding. Determine the source of the problem and apply a solution
  • Must be able to calculate and re-calculate claims, performing (sometimes complicated) calculations, applying formulas using multiplication and percentage
  • Solid working knowledge of standard computer applications including MS Word, Excel Outlook, and PowerPoint
  • Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
  • Communicate clearly and professionally with internal and external customers
  • Work effectively as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
  • Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
  • Pay close attention to detail in all aspects of the job
  • Make decisions using available resources and sound judgment
  • Maintain confidentiality and discretion
  • Identify and resolve problems in a timely manner, gather and analyzes information skillfully
  • Teach, coach, and counsel associates by effectively communicating and providing follow-up.
  • Open to other's ideas and exhibits a willingness to try new things.
  • Demonstrate accuracy and thoroughness; monitor work to ensure quality.
  • Prioritize and plan work activities to use time efficiently.
  • Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
  • Follows instructions, responds to direction, and solicits feedback to improve.
  • Act in such a way to instill trust from management, other associates, as well as customers

Required Knowledge, Skills and Abilities
Physical Demands - The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.
  • Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
  • Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
  • Occasional: Lift and/or move up to 10 pounds
  • Constant: Regular, predictable attendance is required
  • Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.






Essential Functions




Supervisory Responsibility - Supervisor



Work Environment & Systems They Use



Javalena - Eldorado











Position Type Direct hire



Travel None




Other Duties

NICE-TO-HAVEs :

PRODUCTION/QUALITY GOALS (if applicable): n/a
SALARY/RATE $65K - $80K

START DATE: ASAP

DURATION: Direct Hire

LOCATION: Tampa

IF Direct Hire: n/a
-
-Benefits? Yes
Excellent employee & family 100% paid $1500 deductible health plan
3 weeks' vacation

EQUIPMENT N/A

INTERVIEW PROCESS: HR

EMPLOYERS COVID-19 HEALTH PROTOCOL: N/A None

Small company who takes the extra step by offering perks you rarely see.

Culture: They have a Union 7-hour work day 1hour paid lunch

Company demonstrates a commitment to its resources. Ex. the last hurricane Leading Edge provided paid time off and sent each employee $500.00 to assist with loss.

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