Supervisor, Corrected Claim Resolution

Zelis

Remote
  • Job Type: Full-Time
  • Function: Operations
  • Post Date: 04/28/2021
  • Website: zelis.com
  • Company Address: 2 Crossroads Drive, Bedminster, NJ, 07921

About Zelis

Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims.

Job Description

Description & Requirements

Position Overview

Responsible for day-to-day supervision of all certified and non-certified corrected claim analysts and serve as a liaison between Claims Editing and internal Zelis operational departments. The Supervisor will perform administrative tasks as well as provide training for new and existing Corrected Claim Analysts in the proper workflows of all Zelis edits to meet key performance indicators. Will work closely with management to streamline processes, internal controls, staffing, scalability, and quality assurance as it relates to corrected claims.

 

Summary of Responsibilities

  • Direct supervision of Corrected Claim Analysts within the Claims Editing Department; including, but not limited to managing, monitoring, ensuring corrected claims are accurately handled within turnaround time requirements
  • Complete administrative tasks such as payroll, performance evaluations and paid time off requests
  • Mastery of Zelis Claims Editing product offerings as they relate to the corrected claim process and ensure all team members follow proper edit workflows to accurately and efficiently complete provider corrected claims; including, but not limited to: code edit logic, software, and applications
  • Creation and updating of Corrected Claim SOPs
  • Create new and/or improve workflows where identified challenges persist in order to help team meet and exceed KPIs.
  • Mentor, train and develop team members
  • Perform and provide reporting to manager on quality assurance for corrected claims processed according to both Zelis and Client requirements.
  • Capture and sustain associate engagement with consistent communication and outreach
  • Work in collaboration with Manager to keep current on business and department priority needs
  • Utilize the most up-to-date documentation and guidelines when responding to corrected claims
  • Composing responses in a professional and timely manner
  • Create and manage personal development plans in conjunction with HR and Operations Manager
  • Collaborate with Product Services Manager to ensure timely and accurate corrected claim processing
  • Support Operations Manager with reporting
  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy
  • Performs other related responsibilities as assigned
Competencies
  • Demonstrates thorough understanding of inquiry process and edit logic.
  • Demonstrates proficiency in basic math and the ability to calculate savings on corrected claims.
  • Computer proficiency and technical aptitude with the ability to utilize CMS/Prizem and MS Office Applications
  • Strong aptitude in Excel
  • Works on assignments that are complex in nature in which judgment and initiative are required to make recommendations or resolve problems
  • Thorough knowledge of company and departmental policies and procedures
  • High level of understanding in regard to time sensitive issues
  • Recognizes deviations from expected observations
  • Calls attention to results that require analysis
  • Outstanding ability to multiplex tasks as required
  • Attention to detail
Summary of Qualifications
  • Bachelor’s degree, preferred (or equivalent work experience)
  • Current, active CPC or equivalent credentialing, required
  • 3-5 years of managerial and/or supervisory level team leadership in specifically the medical claims processing field within a provider, facility, or payer’s organization.
  • Proven effective utilization of complex workflow processes
  • Excellent professional communication skills, both verbal and written
  • Must be detail oriented with critical thinking and analytical skills
  • Flexibility and adaptability to changes in business priorities and processes
  • Excellent customer service skills
  • Microsoft Office (Outlook, Word, Excel)

Related Jobs

Director of Quality Assurance

Zelis - New Jersey, USAtlanta, GA, US

Client Data Administrator

Zelis - Atlanta, GA, USBedminster, NJ, US

Customer Care Specialist

Zelis - Bedminster, NJ, US

Customer Care Specialist

Zelis - Atlanta, GA, US

Supervisor, Customer Care

Zelis - Bedminster, NJ, US
Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.