Medical Claims Supervisor, Out of Network
Posted on: September 13, 2019
Are you looking for a rewarding new position with an industry
leader with a firm commitment to its employees? Join our team at
MultiPlan! Founded in 1980, we are the industry's most
comprehensive provider of healthcare cost management solutions. We
have almost 1,000,000 healthcare providers under contract, an
estimated 68 million consumers accessing our network products, and
40 million claims reduced through our network and non-network
solutions each year.
JOB SUMMARY: The Supervisor is responsible for managing the
day-to-day planning and operations of the Team. This position is
also responsible for serving as a resource for problem solving;
staffing, service evaluation and enhancement; and
policies/procedures to ensure smooth and efficient operations.
JOB ROLES AND RESPONSIBILITIES:
1. Manage daily operations and processes within the department by
monitoring employee workflow and inventory, including distribution
of claims/work, when applicable.
2. Monitor compliance with all departmental policies, procedures,
and workflows as well as interface with all other internal teams
regarding procedural compliance.
3. Monitor departmental and individual performance metrics and take
proactive action when necessary on a timely basis to maintain
desired workflow outputs; acting upon variances when
4. Develop and implement workflow changes to improve service and
production efficiency of the department; this may include
collaboration with other teams.
5. Collaborate with the training team and all other internal teams
to implement new and revised procedures; which may include
suggested system changes or enhancements.
6. Train, mentor, motivat and oversee staff performance; including
coaching when needed.
7. Manage and review complex and/or difficult claims or issues to
determine best outcome.
8. Partner with internal and external contacts to achieve effective
communications and maximum savings.
9. May act as a liaison in monitoring and supporting specific
client, provider or departmental assignments through reporting and
10. Oversight or research on special projects as assigned.
11. Select, develop, and evaluate staff to ensure the efficient
operation of department.
12. Collaborate, coordinate, and communicate across disciplines and
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company's Core Competencies and values held
15. The position responsibilities outlined above are in no way to
be construed as all encompassing. Other duties, responsibilities,
and qualifications may be required and/or assigned as
Please note due to the exposure of PHI sensitive data -- this role
is considered to be a High Risk Role.
The Supervisor impacts efficiency and effectiveness of team
operations. This is a people management role that has the authority
to initiate and communicate some HR actions (training, new
processes, coaching, mentoring, etc.) but for others, such as
hiring, salary adjustments, position change, termination, and other
disciplinary actions, the incumbent collaborates on such issues
with the next level. The incumbent must have the ability to
exercise discretion and independent judgment to judiciously act in
situations where specific guidelines may not apply.
* Minimum Bachelor's degree or HS Diploma (or GED) and 4 years of
* Minimum 3 years' experience in healthcare industry; preferably
with claims processing, auditing and/or customer service.
* Minimum 2 years' experience in a leadership role
* Required licensures, professional certifications, and/or Board
certifications as applicable.
* Knowledge of claims processing and procedure.
* Knowledge of provider billing and collection practices.
* Knowledge of medical coding systems and commonly used medical
data resources preferred.
* Communication (written, verbal, listening) problem solving,
organization, time management, leadership, and coaching skills
* Ability to convey information clearly, effectively and
* Ability to communicate and process detailed verbal and written
* Able to demonstrate teamwork, organization,prioritization,and
* Ability to be detail oriented to ensure accuracy, including
* Ability to maintain commitment to providing a level of service
within established standards
* Ability to lead, motivate, manage, coach and mentor others
* Ability to elicit trust and credibility with all levels of the
* Ability to identify issues and determine appropriate course of
action for resolution
* Ability to adjust/alter workflow and schedule to meet deadlines
in a fast-paced environment.
* Ability to analyze data and arrive at a logical conclusion.
* Ability to make decisions using limited or incomplete data, when
necessary situations arise.
* Ability to work independently and handle confidential
* Ability to manage multiple projects at the same time.
* Ability to use software and hardware related to job
responsibilities, including MS Word and MS Excel spreadsheets and
* Individual in this position must be able to work in a standard
office environment which requires sitting and viewing monitor(s)
for extended periods of time, operating standard office equipment
such as, but not limited to, a keyboard, copier and telephone
As an Out of Network Supervisor with MultiPlan, you will be part of
an organization with a proud 30-year legacy of experience and
growth. We realize that our employees are instrumental to our
success, and we reward them accordingly with very competitive
compensation and benefits packages, an incentive bonus program, as
well as recognition and awards programs. Our work environment is
friendly and supportive, and we offer flexible schedules whenever
possible, as well as a wide range of live and web-based
professional development and educational programs to prepare you
for advancement opportunities.
Your benefits will include:
* Medical, dental, and vision coverage
* Life insurance
* Optional and dependent life insurance
* Short- and long-term disability
* 401(k) employer matching
* Paid time off (earn 20 days per year)
* Paid company holidays
* Floating holiday
* Tuition reimbursement
* Flexible Spending Account
* Employee Assistance Program
Summer hours = Memorial Day to Labor day we get off two hours early
Opportunity. Recognition. Satisfaction. Grow your career with
As an Equal Opportunity Employer, the Company will provide equal
consideration to all employees and job candidates without regard to
sex, age, race, marital status, sexual orientation, religion,
national origin, citizenship status, physical or mental disability,
political affiliation, service in the Armed Forces of the United
States, or any other characteristic protected by federal, state, or
local law. .
Equal Opportunity Employer Minorities/Women/Protected
Keywords: Multiplan, Irving , Medical Claims Supervisor, Out of Network, Healthcare , Irving, Texas
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