Customer Service Supervisor - Call Center - San Antonio, TX - Full-time / Part-time

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)
 
 
The Claims Supervisor is responsible for coordinating efforts and workflow of the claims inventory team on site and remotely.  Oversight and direct supervision of the claims payment process to ensure accuracy and consistency of data entry methodologies.  This position optimizes use of the system in day to day operations while maintaining integrity of system reporting capabilities.  The Claims Supervisor ensures all medical group referral processes and procedures are universal and comply with CMS standards and Health Plan standards.  This includes referral authorizations, denials, appeals, and reworks, health plan audits, stop loss tracking, transplants, OOA, ER, dialysis and non-contracted provider penalty claims.
 
Primary Responsibilities:


Prepares, reviews, and reports all daily/monthly/quarterly inventory reports for overall management of department

Manages work flow inventory turnaround times in first in first out order to meet expectations of the business plans

Monitors staff quality, production and attendance to include providing monthly 1:1's with performance management feedback to staff up to and including disciplinary action

Effectively plan staff responsibilities and manage activities daily, utilizing staff resources to meet departmental goals including seeking out assistance when needed

Communicate well with Claims Manager, Interdepartmental Management, Senior leadership, providers, and members and assist management with additional duties or projects that are assigned

Approve time cards; coordinate time-off requests while evaluating business needs

Monitors and audits claims payment process to ensure accuracy and consistency, correct usage of referral types, service groups, ICD-9, place of service, CPT/HCPCS codes and messaging fields

Provides feedback to training and management staff

Standardizes claims audit processes and committee meetings between health plan auditors.  Prepares all audit notes and meeting minutes. Functions as the lead during CMS audits

Ensures claims staff understands current information and updates on claims payment processes CMS changes

Acts as a resource to leads, examiners, training or troubleshoot any unknown processes for continuous process improvement

Stay abreast of industry standards, CMS guidelines and ongoing trends that would impact the department.  Any identified impact  work to improve policy and procedures, efficiency for internal and external clients

Serves as a liaison between IPA/Medical Group and claims staff to maximize effective communication, working relationships and operational efficiencies

Supports staffing initiatives by screening, interviewing and selecting new employees for current job vacancies

Performs all other related duties as assigned

Required Qualifications:


Bachelor’s degree in Healthcare Administration or a related field required.  (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)

Two years of supervisory experience

Three plus years of medical claims processing experience in a managed care operating environment

Must have sound knowledge of managed care operations, medical terminology, referral process, claims process, and ICD-9 and CPT coding

Knowledge of Medicare processing guidelines

Familiar with McGraw Hill and RBRVS payment processes

Working knowledge of Microsoft Office applications
Preferred Qualifications:


More than 2 years supervisory experience

More than 5 years medical claims processing experience in a managed care environment

Knowledge of PCTX/Secure Horizons contracts
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Customer Service Supervisor, Call Center, San Antonio, TX, Texas