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Form of workSupervisor, Medical Claims - Electronic Requisition #: 6382 Category: Non-Bargaining # of openings: 1 Location: New York, NY Fund: 1199SEIU Benefit and Pension Funds Pay Range: $57,800 - $72,300 Department: Medical Claims - Electronic Work Hours: M - F, 9:00 a.m. to 5:00 p.m. Position Status: Permanent Workplace Arrangement: Hybrid Employment Type: Full time
Description
Responsibilities
- Supervise, direct and monitor the workflow of staff; review production and performance reports to ensure department goals, quality and standards are met and maintained
- Assist staff with policy questions and complex electronic claims; recall and adjust suspended claims to ensure accuracy of payment based on Fund guidelines
- Conduct audits of Medical Claims Electronic staff to identify where there may be lack of knowledge or re- training if needed; ensure staff is following the audit guidelines and claims processing policies
- Evaluate staff performance, monitor attendance, prepare timesheets, and initiate disciplinary action as needed
- Supervise staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement
- Make recommendations for improvement on policies and procedures for Manager's approval
- Establish a collaborative team environment; coach Quality Control Reviewers and Processors on resolving Medical Claims
- Monitor and evaluate achievement of performance standards (i.e. productivity, accuracy, and attendance); identify strengths, areas for development; create improvement plans, coach and counsel as appropriate
- Perform additional duties and projects as assigned by management
Qualifications
- Bachelor's degree in Health Administration or Business Management required, or equivalent years of experience required
- Minimum three (3) years experience in Medical Claims Quality Control Reviewer in healthcare; to include (1) year in a leadership role and/or training required
- Intermediate skill level in Microsoft Excel and Word preferred
- Extensive knowledge of Medical Claims Processing including electronic claims and billing policies, procedures, CPT, ICD9 codes HCPCS codes
- Good leadership skills and ability to direct and motivate staff; superb communication skills both verbal and written
- Excellent critical thinking and problem-solving skills; able to work well independently and in a team
- Demonstrated organizational skills with ability to multi-task and meet operational deadlines
- Ability to work well under pressure, maintain professional manner and presentation
We offer extraordinary benefits including outstanding health, dental, pension and family benefits for most positions which are paid entirely by the Funds without co-payments, deductibles, or out-of-pocket expenses for covered services. We also offer tuition reimbursement, generous holiday, vacation, and sick leave, as well as a 401K plan.
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