Supervisor, Hospital Claims Position Available In New York, New York

Supervisor, Hospital Claims 1199SEIU Family of Funds – 3.9 New York, NY Job Details Full-time $62,000 – $77,500 a year 16 hours ago Qualifications Microsoft Word Microsoft Excel Mid-level ICD-10 Analysis skills Bachelor’s degree Quality control CPT coding Organizational skills Contracts 1 year Leadership Medical terminology Communication skills Full Job Description Requisition #: 7276 # of openings: 1

Employment Type:

Full time

Position Status:

Permanent Category:

Non-Bargaining Workplace Arrangement:

Hybrid Fund:

1199

SEIU National Benefit Fund Job Classification:

Exempt Responsibilities Supervise the National Benefit Fund (NBF) Hospital Claims front-end Processor/clerical unit staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement Provide support to the unit’s Manager and Assistant Manager in optimizing workflows, distribution and review of work; response to audits, and monitoring of claims production/inventory Ensure timely distribution and processing of claims through the Document Management System (DMS) and QNXT Pend Workflow, and of QNXT Call Tracking; resolve

DMS-QNXT

discrepancies Ensure claims/correspondence are finalized in accordance with member benefit and eligibility parameters; Summary Plan Description provisions; Coordination of Benefits (COB) guidelines; regulatory and pre-authorization requirements; Claim Check and Medicare National Correct Coding Initiative (NCCI) rules; provider/repricing network contract terms and timeframes; and Fund/departmental policies Monitor daily QNXT reports, work queue distribution/completion in the Document Management System (DMS), QNXT Pend Workflow, and QNXT Call Tracking systems Review and assess staff member’s performance with regard to quality/ productivity standards, audit results, and Health Insurance Portability and Accountability Act (HIPAA)/Compliance rules; provide audit rebuttal responses; meet regularly with staff to provide feedback/coaching; develop plans for additional training to remedy shortcomings; take correction action when necessary, to ensure the staff meet departmental/Fund requirements Process high dollar claims at the Supervisor level; serve as back-up to Manager/Assistant Manager in their absence to ensure operational activities are achieved and projects are completed Monitor timely workflow turnaround of documentation between the clerical staff and the Eligibility/COB and Provider Relations/Balance Billing Departments, to support claims finalization Prepare weekly and monthly reports on unit inventory, activities, production, and progress Prepare and maintain attendance/ lateness records and weekly timesheets for payroll to ensure compliance with Funds’ policy and procedures Coordinate testing of QNXT claims processing system in preparation of system enhancements/contract changes, and report/track issues Perform special projects and assignment as assigned by management Qualifications Bachelor’s Degree in Health Administration or equivalent years of work experience Minimum of three (3) years’ hospital claims processing or health claims Quality Control Reviewer/Auditor experience required; to include one (1) year leadership role required Basic knowledge of basic Microsoft Word and Excel preferred Strong knowledge of CPT, ICD-10, HCPCS, UB-04, hospital reimbursement methodologies and contracts Knowledge of eligibility, medical terminology, third-party reimbursement; COB; basic Microsoft Word/Excel Strong analytical, critical thinking, interpersonal and communication skills (written and oral) Good leadership skills and ability to direct and motivate staff Excellent organizational skills; able to multi-task, work well under pressure, prioritize and follow-up