Pediatric Nurse

Position Overview The BH Claims Supervisor will oversee personnel involved in the adjudication of behavioral health-related medical claims. This position will provide support to the ASP Manager and other MetroPlusHealth employees regarding the adjudication of complex, difficult, and non-routine claims for multiple lines of business. The incumbent will coordinate with the ASP Manager to ensure the BH Claims team is able to meet expectations for the timely and accurate adjudication of claims. Scope of Role & Responsibilities Supervise the day-to-day workload of the BH Claims Unit including assignment of tasks Identify issues and problems with claims submissions. Identify system processing issues. Process complex, difficult, and non-routine claims for multiple lines of business. Ensure that training manuals are current, and that policies and procedures are followed correctly Plan, develop, and conduct training programs for staff Provide input to the ASP Manager related to the development and performance of employees Participate in special projects as required. Represent the BH Claims Unit in the absence of the ASP Manager Required Education, Training & Professional Experience Bachelor’s Degree required. Minimum of two (2) years’ experience in HMO claims processing; or A satisfactory equivalent combination of education, training, and experience. Well versed in all the duties and responsibilities of the Claims Examiner position including data entry and system adjudication of BH claims Knowledge of Medicaid policies, as well as enrollment policies procedures. Professional Competencies Integrity and Trust Customer Focus Functional / Technical skills Excellent verbal and written skills Must be able to work in a professional manner with employees, management, and providers LI-Hybrid MHP50