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Claims Supervisor

Company: Christus Health
Location: Irving
Posted on: November 9, 2019

Job Description:

Description
Under the supervision of the Claims Department Manager, this position is responsible for balancing workloads, assisting with the establishment of structure and standardization, creation and updating of departmental policies and process and implementation and maintenance of oversight within the Claims Department. Monitoring of claim processing production and quality are required. Improvement initiatives in increasing claims auto adjudication will be performed. Additional functions of this role are hiring, developing and supervising, employees, managing overall claim inventory, resolving escalated claim issues and assisting Claims Examiners with policy, regulatory or contractual questions and concerns. This position also will assist in audit-related decision making and in training new Claims Examiners on job-specific roles and responsibilities.

MAJOR RESPONSIBILITIES

Claims Examiner hiring, training, and development
KRONOS time tracking
Success Factors: Employee goal-setting, routine rating
Overall employee development
Identify prevalent trends and recommend resolution techniques to management
Delegates work to Claims Examiners as needed
Assists with system emergencies with direction from the IT department and/or appropriate vendor
Assignment of Claims Examiner tasks
Assists in disseminating information to staff as needed
Performs other related duties and special projects as requested
All other duties assigned by management
Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)



Requirements
Analytic ability to organize and prioritize work to meet deadlines
Ability to organize and prioritize work to meet deadlines
Strong computer application skills including Microsoft Word, Excel and Visio
Excellent written and verbal communication skills required
Good judgment, initiative, and problem-solving abilities
Ability to handle and resolve complex issues independently
Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
Knowledge of claims processing, system configuration, edits, adjustment adjudication, and claim department processes
Knowledge of CPT/HCPCS, ICD9 coding, and medical terminology.
Ability to learn new policies and processes based on written material and observation
Ability to establish and maintain professional, positive and effective work relationships

Experience
2 years of Healthcare experience with Managed Care experience required
Prior Claim Team Management experience preferred
Three years of claims processing experience required with Managed Care experience preferred
Claim system configuration experience preferred
Prior experience working with TRICARE, Texas Medicaid, Medicare Advantage highly desirable

License/Registrations or Certificatioins
Driver's License

Keywords: Christus Health, Irving , Claims Supervisor, Other , Irving, Texas

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