Claims SupervisorNational Vision Administrators is seeking an experienced Claims Supervisor to oversee daily operations of the vision eye care claims team. This role ensures accurate and timely Medicaid and Medicare claims adjudication, while maintaining compliance with regulatory requirements and company standards.In-office onsite 5 days a week in Clifton New Jersey, this is NOT a remote role.Key ResponsibilitiesSupervise claims staff and manage daily workflowReview and process complex and high-dollar claimsEnsure accuracy of medical billing and coding (CPT, ICD-10, HCPCS, modifiers)Manage COB/TPL claims and resolve denials/rejectionsEnsure Prompt Pay compliance and regulatory adherenceOversee ManageEngine tickets and escalationsSupport audits, reporting, and quality assurance initiativesTrain and develop team membersQualifications5+ years of Medicaid/Medicare claims processing and adjudication experienceStrong knowledge of: CPT, ICD-10, HCPCS, modifiersCMS-1500 (HCFA 1500) forms and electronic billingTimely filing, resubmissions, appeals, and remittance adviceExperience with COB/TPL and denied claims resolutionFamiliarity with AS400 or similar claims systemsStrong Excel and Microsoft Office skillsExcellent communication and organizational skillsCPC, CPB, or CBC certification is preferredPrior experience in vision plans, optometry, ophthalmology, or eye care billing is preferredNational Vision AdministratorsFor over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health & Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care.
We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.