InfiCare has been providing Contingent Staffing and Direct Hire staffing services to its clients across the US and in four continents Since 2001. Starting from a modest beginning in 2001, today we service clients ranging from Fortune 500 companies to medium sized businesses as well as small niche firms. In US we are based at Dulles, VA. We are hiring "Claims Supervisor (Assistant Manager) at St. Louis, MO 63119 " for one of our clients. If you are interested in this position, you can revert to my email or call me at 703-652-6329.
Job Title - Claims Supervisor (Assistant Manager)
Job Location - St. Louis, MO 63119(In office only)
Duration Full Time/ Permanent
Start Date: ASAP
Job Description
Summary: Under the supervision of the Claims Manager, the Claims Supervisor is responsible for providing support, direction and supervision to Claims Examiners. This position also monitors and supervises various processes throughout the claims cycle and may process claims for assigned groups.
Essential Functions
Supervision and Leadership
Responds to examiner questions and tracks question trends
Assists with providing training for new and existing examiners and assistants
Provides ongoing feedback and support to improve performance of direct reports
Prepares and facilitates performance reviews for direct reports
Reviews and approves time cards and PTO requests for direct reports
Assists with the identification and selection of new employees
Communicates clearly and concisely, with sensitivity to the needs of others
Claims
Monitors claims inventory daily; manages inventory to ensure claims are being processed in a timely manner
Processes overpayments, underpayments, and refund checks
Reviews appeals and assists with determination
Reviews and approves weekly claim batches
Monitors weekly pend report process
Monitors weekly pre-check register process
Assists with researching escalated provider services/client services claims inquiries
Assists with organization and facilitation of department meetings
Additional Functions
Assists with special projects, as requested
Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
Maintains courteous, helpful and professional behavior on the job
Establishes and maintains effective working relationships with co-workers
Follows and ensures departmental compliance with all Policies and Procedures and HIPAA regulations
Maintains knowledge and understanding of current Medicare claims processing guidelines
Attends continuing education seminars/training as requested
Maintains a safe working environment
Supervisory Responsibility: Provides supervision for assigned remote Claims Examiners.
Travel: None
Knowledge, Skills And Abilities
Educational requirements include a High School Diploma or equivalent. A minimum of three years of claims processing experience is preferred. A minimum of one year of supervisory experience is required, preferably in health plan operations.
Solid understanding of CMS-1500 & UB-04 guidelines
Strong working knowledge of CPT, ICD-10, and HCPCS coding, including modifiers
Familiarity with APC and DRG reimbursement
Knowledge of EDI claims
Knowledge and experience using current computer technology, including experience with Excel and Word.
Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
Skilled in data analysis and problem solving using defined methodologies
Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
Ability to be an advocate of the TRHC 32 Fundamentals
Ability to work independently with minimal supervision
Ability to independently follow through on projects
Ability to communicate professionally, clearly and effectively, verbally and in writing
Ability to prioritize effectively
Ability to consistently multitask
Physical Demands & Requirements
Communicates in person and via telephone with staff, participants, customers, and vendors
Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
Remains stationary for extended periods of time
Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
Occasional reaching to retrieve shelved items
Occasional bending/stooping
Work Environment
This job operates in a home office environment
No substantial exposure to adverse environmental conditions is expected.
Moderate pressure to meet scheduled appointments and deadlines
Regards
Helen Stokes
InfiCareTechnologies | 22375 Broderick Drive #225 Dulles VA 20166 |