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Claim Resolution Supervisor at athenahealth in Belfast, ME

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Description

Claim Resolution Supervisor- Claim Tracking

The Claim Resolution department, a division of Claim Operations, is responsible for the research and appropriate resolution of previously submitted medical claims. These claims have either been denied by the payer(s) or their benefit determination/adjudication is unknown. The department is organized as two focused zones; Claim Tracking and Denials Management. Both of the zones are staffed by Revenue Analysts who focus their efforts upon the timely and appropriate resolution of their designated claims, on behalf of athenahealth's Collector clients. This is specific to the Claim Tracking business.

Position Description:

The Claims Resolution Supervisor is responsible for the direct, day-to-day supervision of a team of Revenue Analysts. S/he is specifically responsible for ensuring that all staff members have the appropriate training, tools, and guidance required to meet department production and quality performance targets on a daily, weekly, and monthly basis. The Supervisor monitors production throughout the course of the day. Working cooperatively with BPO partners as well as Claim Resolution in Chennai, they allocate staff resources, and work volume to address production needs across multiple geographies. The Claims Resolution Supervisor is responsible for staff schedules, time management, pulse checks, appraisals and any required disciplinary action under the guidance of their Manager. Additionally, the Claim Resolution Supervisor is responsible for engineering and implementing viable process enhancements that will positively impact the Claim Resolution business. 

The Supervisor will report to the Manager of Claim Tracking.

Responsibilities:

* Supervising a team of Revenue Analysts focused on meeting timeliness and quality standards in order to meet/exceed client expectations;
* Monitoring daily and weekly process controls to meet departmental quality and effectiveness metrics;
Build and maintain an effective, working relationship with BPO partners and the Claim Resolution team in Chennai, and encourage frequent- effective communication in order to foster an environment of transparency between the two geographies
* Evaluating, implementing, and continually assessing/optimizing a team structure, as well as business processes, policies and procedures to ensure the efficiency and effectiveness of the claim resolution process.

Additional responsibilities may include, but are not limited to:


* Assist with new hire on-boarding (interviewing, training, and assessing)
* Monitor and deliver bi-weekly quality assurance assessments for staff
* Kronos, time management, administration/staff scheduling/time off approval
* Write performance management assessments (including appraisals and pulse checks) for direct reports
* Conduct weekly team meetings
* Attend weekly inter-department meetings, as needed
* Attend management meetings onsite at Watertown HQ, as needed
* Ensure timely completion of assigned SugarCRM tasks
* Administer special projects as assigned by Claim Resolution Director
* Other duties as assigned by the Manager, Claim Tracking

Qualifications:

Specific Requirements of the Supervisor:
* Bachelor's degree or equivalent experience;
* Previous supervisory experience preferred;
* Ability to evaluate personnel performance against established goals;
* Requisite knowledge of medical billing desired but not required;
* Prior experience enforcing and maintaining department policies and procedures, with a focus on continuing staff education;
* Demonstrated ability to assume sole and independent responsibility for various assigned projects;
* Ability to exercise discretion and independent judgment with respect to significant matters;
* Strong analytic and problem solving capabilities;
* Ability to continually assess and redesign business processes to exceed MSC (minimum service commitment) performance and reduce overall unit cost structure;
* Excellent communication skills, including listening, writing, and relationship development;
* Strong organizational skills and attention to detail;
* Flexibility: comfort working in a rapidly changing, diverse environment;
* Initiative - Not only able, but also excited by the prospect of working in a fast-paced, hard-working environment.

Required of all Claim Resolution employees:


* Understanding of the needs of our clients and how attainment of our goals will meet those needs;
* Focus on quality of service as our driving principle;
* Understanding the business need to set and attain ever more challenging goals;
* Understanding of, and dedication to, continuous improvement of our processes and ourselves to support athena's mission;
* Eagerness to participate in change-oriented endeavors geared toward expanding our capabilities;
* Willingness, as part of a team, to personally provide at least 51% of the commitment and effort required to solve a problem;
* Willingness to vary job responsibilities as required to meet the needs of our clients;
* Desire to learn as much as possible about our core systems;
* Mastery of all Microsoft Office applications, including Outlook, Word, Excel and Powerpoint.



 

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