Supervisor-Claims (Full-time hybrid, Morrisville, North Carolina Based)

The Claims Supervisor is responsible for oversight of claims data entry, payments, credits, and adjustments; training and development of Claims Research Analyst team members; claims auditing for performance; measuring and maintaining productivity; complex decision making; and information management system analysis. The Claims Supervisor provides guidance and oversight of the training/technical assistance offered to provider agencies in an effort to strengthen the performance of Alliance’s provider partners.

Education & Experience

Bachelor’s degree from an accredited college or university in Business Administration or related field and three (3) years of experience in claims leadership experience with focus in leading projects and people.

Preferred: Experience in Behavioral Healthcare agency and knowledge of CPT codes, Medicaid, and IPRS preferred. 

Supervise Claims Operations

• →Compile performance reports, monitor and record measures and evaluate operations needs and work level requirements
• →Execute and implement new procedures and updates as directed by the Claims Manager/Sr. Director 
• →Assess claims production and quality levels for performance and monitor Provider/Member feedback
• →Ensure staff are taking appropriate steps for claims resolution including escalation when necessary
• →Ensure the setup and maintenance of the billing and reimbursement system
• →Review and analyze daily, weekly and monthly reports to help track processes, implement procedure and department changes to increase productivity and monitor staff in achieving department standards
• →Stay abreast of related regulatory, compliance and departmental updates to meet departmental metric requirements
• →Assist the Claims Research Analysts in reviewing claim errors
• →Develop, implement and modify policies and procedures to ensure claims are valid and settlements are made according to policies and procedures
• →Ensure providers are paid by the prompt pay guidelines
• →Track special projects as assigned and by necessary completion date
• →Maintain relationship with providers to obtain additional information as necessary
• →Identify areas of inefficiency and develop innovative approaches to eliminate inefficiencies
• →Identify and support resolution of internal issues creating claims barriers for providers and Alliance

Manage and Develop Staff

• →Work with Human Resources and Claims leadership to attract, maintain, and retain a highly qualified and well-trained workforce.  
• →Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes.
• →Organize workflows and ensure staff understand their roles and responsibilities.
• →Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements.
• →Actively establish and promote a positive, diverse, and inclusive working environment that builds trust.  
• →Ensure all staff are treated with respect and dignity
• →Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members.
• →Work to resolve conflicts and disputes, ensuring that all participants are given a voice.
• →Set goals for performance and deadlines in line with organization goals and vision.
• →Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development.
• →Cultivate and encourage efforts to expand cross-team collaboration and partnership.

Collaboration 

• →Collaborate with Contracts, Credentialing, Enrollment, Provider Network teams to assist providers with successful claims submissions; Maintaining a working knowledge of Provider Network functions to appropriately advise/guide providers with claims-related issues
• →Collaborate with Utilization Management to resolve and manage system changes to allow for successful claims adjudication
• →Participate in various internal agency efforts that may include, Peer Reviews, Data Analytics, Data Governance, Appeals, Grievance Resolutions

• Ability to resolve complex problems that require the evaluation of alternative methods and solutions
• Ability to set objectives, delegate, and prioritize workflow
• Proficient in written and oral communication sufficient to handle projects and problems
• Ability to develop strong working relationships
• Proficient in the techniques of research, statistical analysis and report presentation
• Ability to make prompt decisions on complex matters and make evaluations concerning day to day operations
• Ability to prepare concise and accurate reports and plans
• Working knowledge of financial and budgeting systems
• Excellent customer service skills
• Knowledge of Medicaid and IPRS rules

$69,592 -$88,729/Annually