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About the Role
As a Claims Supervisor, you will review claims and supporting documentation from providers and health plans to make accurate eligibility determinations for disputed claims. You will oversee the workflow of assigned Claims Specialists, ensure quality and productivity standards are met, and provide training on intake, eligibility review, and the handling of single, bundled, and batched cases. Success in this role requires strong attention to detail, sound judgment, a collaborative approach, and a commitment to delivering excellent customer service within the Federal IDR Process and other state and federal programs.
Responsibilities
- Review assigned case documentation and determine whether disputes qualify for the Federal IDR process.
- Manage the daily operations of assigned Claims Specialist teams.
- Track team productivity, conduct performance evaluations, provide coaching and feedback, and take corrective action when needed.
- Oversee employee performance metrics, timesheet approvals, time-off requests, reporting requirements, and new hire onboarding activities.
- Ensure employees meet quality standards and delivery deadlines, resolve production issues, and escalate concerns to senior management as needed.
- Manage workflow, assign responsibilities, and hold team members accountable for results.
- Set performance goals and deadlines aligned with company objectives and report variances to senior management.
- Maintain accurate timekeeping and personnel records.
- Train new employees and provide ongoing training on intake and eligibility processes.
- Lead team huddles and project meetings, identify recurring issues, and implement solutions.
- Work directly with customers to resolve concerns, discuss case scenarios, and communicate process updates and directives.
- Complete tasks assigned by direct manager, including case intake, eligibility review, case follow-up, and other projects as needed.
Requirements
- Motivate employees by resolving issues and making sound decisions
- Serve as a conduit of communication between employees and senior managers
- Ability to problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
- Strong ability to motivate team members
- Detail oriented mindset, excellent organizational skills, and ability to adhere to deadlines
- Ability to supervise, manage and coordinate team members to positive outcomes.
- Excellent written and verbal skills.
- Ability to work independently with little supervision.
- Ability and desire to be flexible, innovative, and creative while multi-tasking.
- Ability to meet deadlines in a time sensitive environment.
- Familiarity with CMS Federal IDR Process billing rules and regulations.
Location
- Jericho, NY
Work Type
- In-office
Experience Level
- Two (2) years’ experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory
- One (1) year experience working in Independent Dispute Resolution
Education Level
- Bachelor’s or advanced degree in healthcare, business, or related field
Salary/Compensations
- $82,500.00 to $86,500.00
About the Company
- IPRO is an Equal Opportunity Employer.
Equal Opportunity
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.