Job Number: 1186
Position Title: Claims Supervisor
The Claims Supervisor is responsible for supervising Alignment Healthcare’s Claims production staff, ensuring policies, procedures and guidelines are administered appropriately and claims metrics and goals are met as established by CMS, Alignment and other regulatory agencies. The Supervisor duties performed are as follows:
- Provide daily direction and communication to Claims production team to ensure claims are completed in a timely manner to adhere to compliance requirements.
- Provide continual evaluation of processes and procedures providing evaluations for improvement/development.
- Train new staff and re-train tenured staff on new processes.
- Serve as Claims subject matter expert, answering questions for staff and other departments
- Handle complex claim cases as well as review high dollar claims for accuracy
- Monitor claims metrics and develop corrective action plans when necessary.
- Monitor productivity and quality of individual staff’s completed assignments.
- Provide regularly scheduled one-on-one coaching with staff.
- Handle escalated customers’ questions and concerns.
- Updates systems, tracking tools or other documentation methods as needed.
- Identifies data trends and reports findings to department management with suggestion for resolution and opportunities for process improvement.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in the department policies and procedures relating to HIPAA Compliance.
- Ensure information flow of updates and changes to staff for developing and motivation.
- Establish creative ways to increase team performance
- Other duties as assigned
- High School Diploma.
- 2+ years of Supervisory experience with a Health Plan or Medical Group (Medicare preferred).
- 5+ years of any of the following combined: claims auditing, claims processing, claims dispute/appeals processing, claims customer service.
- Knowledge of claims processing systems (EZCAP preferred).
- Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc.
- Experience in processing/adjudicating medical, hospital claims.
- Experience in handling provider payment disputes and appeals is preferred.
- Proven problem solving skills and ability to translate knowledge to the department.
- Working knowledge of Microsoft Office Products.
- Ability to multitask.
- Strong Organizational Skills.
- Attention to Detail.
- Ability to use 10 key.
- Familiarity with CMS regulatory requirements.
Essential Physical Functions:
The physical demands described here are of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Location City: Tampa
Location State: Florida
Community / Marketing Title: Claims Supervisor
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact email@example.com.