Claims Denials Supervisor- MDLIVE Position Available In Broward, Florida
Tallo's Job Summary: The Claims Denials Supervisor position at MDLIVE involves monitoring denials-related revenue, supporting direct reports, and implementing coding procedures. Qualifications include a degree, 5+ years of relevant experience, and proficiency in various software. The anticipated annual salary ranges from 53,300 to 88,900 USD, with benefits such as health insurance, 401(k), and paid time off. Evernorth Health Services, a division of The Cigna Group, is hiring for this role.
Job Description
Claims Denials Supervisor- MDLIVE
This job is available in 12 locations See all Category
Customer Service & Claims Posted Date:
05/07/2025 Job Id
25005461
POSITION SUMMARY
Expanding access to affordable, high quality health care starts at MDLIVE. At MDLIVE, innovative ideas in healthcare are created every day. The Denials Supervisor is responsible for monitoring all denials related aging revenue by reviewing, trending, and tracking all claims rejected and/or denied by system edits and or payer. This role will support 10+ direct reports with ongoing training, mentoring, and install proper KPIs.
ESSENTIAL FUNCTIONS
Engages cross-functionally to problem solve client claim issues
Assists in implementing physicians’ queries when appropriate and interacts with credentialing staff as per account requirements
Follows the Official ICD-10-CM, CPT, and HCPCS Guidelines, AMA CPT Guidelines, and CMS directives, as related to claim denials and appeals
Pursues collection activities to obtain reimbursement from payers and/or patients
Frequent follow up with payers and/or patients on outstanding accounts
Sets daily standard work for denials team
Assigns claims to team via Athena worklist
Runs metric reports and coach team to reach their goals
Develops and implements coding RCM procedures by analyzing current procedures, recommending changes, and creating SOP’s
Answers internal/external client questions by researching and interpreting data
JIRA ticket management – maintain denials related Jira tickets within 30 days
Monitors and sets action plan to reduce denials and rejections
Works cross functionally to solve outstanding claim issues
Must be able to read and understand a payer/client contract
Works payer projects, with short timelines
Demonstrated ability to problem solve and utilize analysis experience and judgement to make accurate decisions
Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
QUALIFICATIONS
Associate’s/Bachelor’s degree preferred or equivalent relevant work experience
5+ years of Telehealth, Urgent Care, Primary Care, Wellness Care, Behavioral Health Care, Dermatology denials experience preferred
5+ years of supervisor or manager experience preferred
2+ years minimum of front and back-end office experience
Working knowledge of payer implementations
Proficiency in working with Athena, Excel, pivot tables, Outlook email, Salesforce
Working Knowledge of Health Insurance EOB’s, denials and appeals
Ability to meet assigned deadlines
Strong understanding of claims cycle
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 53,300 – 88,900 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process,
