Supervisor, Claims Department

Details: Category: Leadership/Management Facility: Phoenix Health Plan/Abrazo Advantage Health Plan Department: Claims Processing Shift: Day Shift Hours: M-F, 8-5 Contact Information:  High School/GED Overview: This position supervises the commercial claims processing team for the VBIC (Valley Baptist Insurance Company) line of business for Advantage Healthcare Management Company. Supervisor creates training materials, facilitates training and handles the Claims Medical Review process. Primary duties include: • Daily supervisory functions that includes oversight and monitoring of the VBIC claims • Develops various training materials for processing all claim types and implementing new procedures • Provides complete medical review for UB and HCFA claims for VBIC as identified by the health plan including supporting claim department staff by providing clarification of medical terminology and practical application of code review edits • Functions as an effective part of the Claims Management Team by keeping Managers and Director informed and updated on issues surrounding designated areas, participating in meetings, working with other management staff on special projects and identifying areas of improvement with recommendations for workflow changes • Assists in creating policies and desktop procedures as well as implementing workflows surrounding designated areas • Ensures effective interdepartmental communication, workflow and procedures are in place to meet the goals of the department and the health plan • Provides input for direct reports regarding disciplinary actions, rounding, performance appraisals, etc. • Assists with and completes special projects in a timely manner as directed by management Special Skills: Must be highly motivated; organized; professional; and have excellent written and verbal communication skills with demonstrated proficiencies in Microsoft Office products (Excel, Word & Power Point-Access a plus). Required Licensure: Medical Coding and Billing Certification Minimum Requirements: High School graduate, GED or equivalent required. Minimum of 10 years Claims Processing experience; 5 years Supervisory experience; 5 years functioning as a Certified Medical Coder and previous training experience. Preferred Qualifications: Secondary education preferred. Prefer prior training experience, experience with Commercial group plans, benefit administration, and contract interpretation as well as claims processing.

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