Claims Processing Supervisor

Claims Processing Supervisor at AllCare HealthWe are seeking qualified candidates to join our team! AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.Summary of the Position: The Claims Processing Supervisor ensures that all internal and external departmental performance requirements are consistently met. This role oversees the day-to-day activities of the claims processing team, determines work assignments and efficient workflows to meet contractual obligations, and serves as a hands-on resource for staff on training, questions, and claims processing best practices.Essential Duties:Provide one on one support, initial training for new hires and monthly mandatory training sessions for all claims processing staff.Establish and maintain a professional, supportive, provider service-oriented workplace culture with high standards of individual and team performance.Maintain production and quality monitoring logs and reports for both individual and overall departmental performance.Job Duties:Supports and contributes to AllCare's mission, vision, and values.Maintains and monitors internal audit procedures to ensure staff compliance with departmental policies, procedures, and quality standards.Ensures claims processing procedures are followed consistently and provides coaching or retraining as needed.Maintains compliance with departmental policies and procedures related to HIPAA and protected health information (PHI).Reviews, develops, maintains, and updates claims processing procedures, reference materials, and training resources.Maintains a working knowledge of the duties, processes, and workflows performed by all positions supervised.Organizes team workflow and assigns responsibilities to ensure appropriate coverage, including during staff absences.Monitors individual and team productivity and quality and provides regular, constructive feedback.Identifies and addresses employee performance, attendance, and workplace concerns in accordance with organizational policies and procedures.Conducts performance evaluations for direct reports.Maintains clear and accurate documentation of employee performance discussions, coaching, and disciplinary actions.Identifies and communicates system needs, process improvement opportunities, operational concerns, and staff-related issues to department leadership.Demonstrates professional and respectful communication and behavior when working with employees, leadership, providers, and other stakeholders.Maintains punctual, regular, and predictable attendance.Works collaboratively within the department and across teams to support effective claims operations.Respectfully receives and follows direction from the Sr. Claims Processing Manager and/or VP, Claims Administration & Payment Integrity.Completes all required training, including assigned Relias Learning Management System (LMS) training.Performs other duties as assigned.On Call Responsibilities: This position does not have any on call responsibilities.Supervisory Responsibilities: Directly supervises 9 to 11 (nine to eleven) employees in the Claims department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.

Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.Qualifications:Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.Education:Highschool Diploma or equivalent required.Bachelor's degree (BA) from a four-year college or university preferred; or equivalent combination of education & experience.Experience:2–4 years' experience in managed care, Medicare, and/or Medicaid claims processing (or an equivalent combination totaling at least 2 years), with a solid understanding of core claims concepts such as co-pays, deductibles, co-insurance, coordination of benefits, and pre-existing conditions, and demonstrated knowledge of claims workflows and adjudication practices.Extensive knowledge of medical terminology and coding systems, including ICD-9, ICD-10, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Diagnosis Related Grouper (DRG), Resource Utilization Groups (RUG), and Health Insurance Prospective Payment System (HIPPS) codes.Knowledge of CMS 1500, UB-04, and other applicable claim forms, both paper and electronic.Ability to research and resolve errors resulting in refunds and adjustments.Prior supervisory, lead, or training experience strongly preferred.Certificates, Licenses, and/or Registrations:AAPC certification such as CPC, CPB, or CPMA required within 12 months of hire. Equivalent nationally recognized coding, billing, or medical auditing certification may be considered.Technical Skills:Familiarity with the Healthcare industry.Exceptional writing, editing, and proofreading skills.Excellent organization and time-management skills.Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).Knowledge of and compliance with HIPAA regulations.Excellent at breaking a project into definable and measurable tasks and tracking progress to completion.Knowledge of research methodologies and/or data analysis.Excellent at interpreting data and using it to solve problems and gain new insights.Excellent at locating information and synthesizing information from various sources.Knowledge of customer service and service recovery best practices.Excellent customer service skills to respond appropriately and interact positively with upset customers.Knowledge of phone customer service best practices and experienced with multi-line call centers.Knowledge of training best practices and adult learning principles.Excellent at training development and/or delivery.Knowledge of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.Interpersonal Skills:Trust: Promotes honesty, transparency, and diligence. Approaches leadership with mindset of "power with" rather than "power over" and regularly includes others in planning and decision-making. Able to make and communicate difficult decisions in the best interest of AllCare Health.Innovation: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization. Commits to solving unresolved issues in an effort to collaborate and model problem solving. Proactively develop solutions to challenges, including by constantly looking at big-picture progress and thinking about people.Relationships: Enthusiasm for meeting and engaging with people. Able to put people at ease, especially when there are lines of difference. Identifies and intervenes in problematic dynamics. Listens closely to understand needs or concerns and takes steps based on that input. Gets back to people in a timely manner. Takes pride in providing clear, helpful information.Voice: Brings a clear vision and recognizes the value of divergent perspectives. Provides equity-centered conflict transformation support, interventions, and training in the team and across departments. Commits to and understands concepts of equity, belonging, and inclusion in the workplace. Effectively works and collaborates across differences. A working knowledge and understanding of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.Language Skills:Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.Mathematical Skills:Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.Computer Skills:Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.Reasoning Ability: