Claims Resolution Manager(Job Number:
United States-Tennessee-Brentwood-Nashville Physician Service Center
Directors & Managers
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
Claims Resolution Manager
Job Summary – The Claims Resolution Manager is responsible for providing supervision and structure for the department’s daily operations and functions. The Manager works to meet or exceed department productivity and quality standards by coordinating staffing and developing efficient workflows. The Manager guides the staff in their day-to-day responsibilities, including mentoring and training the staff as needed. Proficient in facilitation and interpersonal communication, the manager also consistently demonstrates skills in organization, prioritization, professionalism, and coaching others.
Supervisor – Claims Resolution Director
Supervises – Claims Resolution Specialist, Claims Resolution Team Lead, Auditor, Auditor Team Lead
Duties (included but not limited to)
- Coordinate and communicate continuously with other departments to share information, best practices, systems issues, process solutions, and training needs
- Oversee the claims resolution process
- Proactively review and provide data analysis and financial impact assessment
- Ensure compliance with company and departmental policies and procedures
- Establish and review internal controls to ensure goals, objectives, standards, and benchmarks for the department are met or exceeded
- Determine staff hours, number of personnel, and resources required for efficiency
- Screen, interview, and hire new employees
- Evaluate staff and Team Lead performance and recommend appropriate merit increases and promotions
- Counsel staff and Team Leads regarding disciplinary and performance issues
- Mentor staff and Team Leads for career development
- Ensure training needs are met
- Conduct regular staff meetings
- Maintain working knowledge of workflow, systems, and tools used in the department
- Promote continuous improvement and best practice in processes and performance for improving billing, timeliness, and ensuring data accuracy
- Lead in the creation and maintenance of a positive working environment
- Review employee engagement results and facilitate the development of action plans
- Review, correct, and approve employees’ hours in a timely manner
- Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
- Other duties as assigned
Knowledge, Skills, and Abilities
- Organization - proactively prioritizes needs and effectively manages resources
- Communication - communicates clearly and concisely, verbally and in writing, including utilizing proper punctuation and correct spelling; able to communicate with staff, Parallon Management, and Division and Group Executives.
- Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
- Interpersonal skills - able to work effectively with other employees, patients, and external parties
- PC skills - demonstrates proficiency in Microsoft Office applications and others as required
- Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
- Tactical execution - oversees the development, deployment, and direction of complex programs and processes
- Project Management - assesses work activities and allocates resources appropriately
- Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures, and systems
- Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem solving skills, and attention to detail; and able to perform basic mathematical calculations, balance and reconcile figures, and transcribe accurately
Bachelor’s Degree in Business or related field required. Equivalent work experience may substitute education requirements.
Minimum three years’ experience in related area preferred with two of these years being healthcare management experience or completion of the Parallon Manager Trainee Program.
Physical Demands / Working Conditions– Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting papers/boxes and pushing/pulling up to 25 pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.
OSHA Category– The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid, or to be potentially exposed in some other way.