Claims Processing Supervisor at AllCare Health with the Claims department!
We 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 telecommute, remote work, 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
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Provide one on one support, initial training for new hires and monthly mandatory training sessions for all claims processing staff.
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Establish and maintain a professional, supportive, provider service-oriented workplace culture with high standards of individual and team performance.
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Maintain production and quality monitoring logs and reports for both individual and overall departmental performance.
Job Duties
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Assist in maintaining and monitoring internal audit procedures to ensure staff compliance with policies
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Support internal audit procedures to ensure staff compliance with company policies and procedures.
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Ensure desktop procedures are followed consistently and provide retraining as needed.
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Maintain and support department policy guidelines for HIPAA and PHI compliance.
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Review, create, maintain, and update desktop procedures and reference materials for claims processing staff.
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Assist in developing and updating relevant policies, procedures, and training materials.
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Learn and maintain a working understanding of the job duties of all positions supervised.
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Organize workflow and delegate responsibilities to reporting staff, including coverage during absences.
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Monitor team productivity and provide regular, constructive feedback.
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Identify and resolve workplace issues, including attendance and performance concerns.
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Conduct annual performance evaluations for direct reports.
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Prepare clear, detailed documentation of employee conversations and disciplinary actions.
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Communicate needed system changes, process improvement ideas, and staff concerns to the direct supervisor.
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Effectively communicate to your direct supervisor any needed system changes, ideas for department process improvements, concerns, and staff issues.
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Respectfully takes direction from the Sr. Claims Processing Manager and or the VP, Claims Administration & Payment Integrity
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Demonstrates effective behavior and communicates in a respectful and professional manner
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Maintains punctual, regular and predictable attendance.
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Works collaboratively in a team environment with a spirit of cooperation.
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Meets all required training including those listed in Relias Learning Module System (LMS).
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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
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Highschool Diploma or equivalent required.
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Bachelor's degree (BA) from a four-year college or university preferred; or equivalent combination of education & experience.
Experience
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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.
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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.
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Knowledge of CMS 1500, UB-04, and other applicable claim forms, both paper and electronic.
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Ability to research and resolve errors resulting in refunds and adjustments.
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Prior supervisory, lead, or training experience preferred.
Certificates, Licenses, and/or Registrations
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CPC, CPMA, CPCB or CPC-P coding Certification required to be obtained within 12 months of hire.
Technical Skills
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Familiarity with the Healthcare industry.
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Exceptional writing, editing, and proofreading skills.
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Excellent organization and time-management skills.
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Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
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Knowledge of and compliance with HIPAA regulations.
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Excellent at breaking a project into definable and measurable tasks and tracking progress to completion.
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Knowledge of research methodologies and/or data analysis.
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Excellent at interpreting data and using it to solve problems and gain new insights.
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Excellent at locating information and synthesizing information from various sources.
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Knowledge of customer service and service recovery best practices.
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Excellent customer service skills to respond appropriately and interact positively with upset customers.
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Knowledge of phone customer service best practices and experienced with multi-line call centers.
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Knowledge of training best practices and adult learning principles.
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Excellent at training development and/or delivery.
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Knowledge of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.
Interpersonal Skills
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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.
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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.
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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.
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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
Ability to solve practical problems and work with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Physical Demands & Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.
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The employee must be able to work onsite as needed.
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The employee may be able to work from a home office occasionally.
Company Overview
AllCare Health Website: https://www.allcarehealth.com.
AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)
AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.
The AllCare Health family of businesses is guided by our corporate principles:
Purpose | Working together with our communities to improve the health and well-being of everyone.
Values | Trust, Innovation, Relationships, and Voice.
Vision | Thriving, Inclusive, and Equitable communities.
Brand Promise | Changing Healthcare to Work for You.
AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others.
If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.
