hero

Join TechBio Companies Driving Patient Impact

Sponsored by Alix Ventures

Post a job // Join our newsletter
BIOS Community
BIOS Community
309
companies
1,961
Jobs

Claims Supervisor

Curative

Curative

Administration, People & HR, Operations
Austin, TX, USA
Posted on Wednesday, May 22, 2024

Curative is searching for an experienced Claims Supervisor. This position successfully manages the day-to-day activities of the Claim Team.
Performs all duties below while maintaining compliance and confidentiality
and promoting the mission and philosophy of the organization.

ESSENTIAL DUTIES AND FUNCTIONS:

  • Successfully manages the day-to-day operations of the Curative Claims Team
  • Serves as a key point of contact for audits, claims payments, questions, and
    customer service.
  • Ensure consistent training, auditing, and feedback is given to all staff.
  • Consistently ensure the Claims Team meets/exceeds the following standards:
  • Claims processing turn around.
  • Procedural and financial accuracy
  • Payment Cycle Review
  • Manage the repricing process for non-par and OON claims in accordance with
    turnaround time standards and client specifications.
  • Work closely with IT, Medical Services, System Support, to ensure efficiency.
  • Work with Accounting, Executive and HR departments to define needed
    processes.
  • Reviews High Dollar Claims for completeness and approves or denies payment
    using established guidelines and making all required internal notifications.
  • Clearly and concisely documents claim adjudication decisions in Claim Notes.
  • Works with the System Configuration department to ensure proper benefit
    setup.
  • Completes required sample of professional and facility claims to audit for
    accuracy, as required by the client.
  • Completes focused audits for error trends identified during processing or pre-
    release audit.
  • Identify claim analyst training opportunities and provider billing issues.
  • Submits audit results to the Claims Manager for review and final submission
    to clients.
  • Acts as claims team resource for claims questions and benefit interpretation.
  • Provides claim staff training via email alerts and training sessions.
  • Reviews results of all prospective/retrospective audits provided from various sources to ensure that claims processing is handled, as mandated, by client directives.
  • Analyzes, tracks and trends provider, system setup and claim errors.
  • Works on claims team projects and reporting, assigned.
  • Assists with all groups for professional and facility claim processing.
  • Attend departmental training when required or requested.
  • Adheres to the rules and regulations of Curative as described in the Employee Handbook and as defined in the unit/department/clinic procedures.
  • Performs other duties and projects assigned.

MINIMUM QUALIFICATIONS:

Education:
● High school diploma or equivalent. Bachelor’s /Associate degree preferred.

Experience:
● At least 3-5 years of Claims Supervisor and/or Management experience required,
including HMO, PPO, ERISA, and government plans experience.
● Experience working with Health Edge- Health Rules Payer system, a variety of
claims payment systems, processing of all claim types, to include hospital/facility,
behavioral health, dental, vision, and professional medical claims. Experience
working with the VBA claims system. Customer Service experience preferred.

Knowledge, Skills, and Abilities:
● Ability to communicate with all levels of staff.
● Advanced Knowledge of claim coding and editing rules
● Knowledge of TDI regulations and requirements for claims payments
● Knowledge of HIPPA regulations
● Knowledge of medical terminology, IDC-10 CPT, and HCPCS coding.
● Proficient computer skills to include Microsoft Office applications.
● Excellent verbal and written communication skills
● Ability to communicate clearly and effectively.
● Ability to sit for extended periods of time at a computer workstation.

PHYSICAL DEMANDS:
SEDENTARY (requires lifting to 10 lbs., carrying small objects)