Technical Claims Supervisor
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.
The Technical Claims Supervisor is responsible for recruiting, training and direct supervision of a team of the technical claims staff, which includes Auditing, COB investigation, Recoveries and Subrogation. Oversee daily operations of the team, trains, mentors, coaches, supervise, and evaluate individual staff performance of team members. Participate in the planning, implementation, and evaluation of the Technical claims area to ensure quality and compliance with Medicaid, Medicare, Minnesota statute and contractual requirements are met, including MSP (Medicare Secondary Payor Rules). Ensure that resources are maximized and efficiencies gained through the identification of process gaps. Complete monthly reporting duties and participate in internal/external meetings and work groups. Specific duties and responsibilities include:
- Recruit, interview and select new staff. Train, monitor and coach employees including maintaining the daily schedules and workflow. Document and provide performance feedback in a timely manner
- Assist with the development of department goals and performance measurements based on the identification of potential issues or trends.
- Manage Technical Claims areas workload to ensure department goals are met including service level agreements.
- Work with Manager to design and complete monthly report of department activities, issues and accomplishments
- Actively participate in cross functional departmental implementation teams of new processes, software and products. Assist the I.S. department with testing of upgrades for new or existing products. Conduct testing, training and update procedures.
- Serve as first point of contact for UCare employees by providing accurate policy interpretation and information, assist with the resolution of complex issues, referring as appropriate to other staff or resources.
- Work with appropriate staff to update and maintain department work instructions. Develop and revise work instructions to effectively deal with claims issues. Communicate changes in timely manner.
- Attend department and other meetings including representing the Claims Department or UCare at internal or external meetings upon request.
- Maintain positive and professional working relationships with staff and other departments to ensure departmental or cross-departmental issues are resolved in a timely manner.
- Analyze processed claims data, adjustment reason codes, adjustment projects, recovery data and all other supporting documentation to identify payment/denial trends. Implement/initiate necessary changes to Claims work instructions and system configuration.
- Other projects and duties as assigned
Associates degree or Bachelors degree preferred with course work in medical terminology, CPT-4 and ICD-9 coding required. Relevant work experience will be considered in lieu of a degree.
One to three years supervisory or leadership experience required. Minimum three to five years claims experience in Medicare, Medicaid, HMO and/or indemnity claims processing, Auditing, Recoveries/Subrogation, CPT and ICD-9 coding, Coordination of benefits/rules established by the NAIC, including MSP and medical terminology and anatomy required. Experience with CMS guidelines and DHS claims processing guidelines, provider contracts and benefit set-up.
Working knowledge of Medicaid, General Assistance, Medical Assistance, Minnesota Care and Medicare helpful. Previous Amisys Claims System, MACESS Exp and training experience a plus.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.