Claims supervisor Jobs in Portland, OR

Description : Job Summary :

Supervise the Occupational Health Claims / Billing Administration, activities and other relevant daily operational needs of the OH department. Serve as supervisor to staff for assistance with routine and non-routine problems. Identify and report system problems and facilitate changes needed to enhance service, increase revenue capture and optimize billing and collection functions Act as project lead or resource for OH Claims / billing administration for Healthconnect updates and testing. Develop guideline and policies which are cost effective, meet the needs of our customer service, allow for streamlined processes throughout the department and support regulatory compliance.

Essential Responsibilities :

• Supervisedaily claims / billing and collection activities : Ensure state and federal regulatory and contract compliance to all aspects of claims processing and billing / collection practices. Plan and assign work schedules and priorities, staffing appropriately; authorizing time off, overtime and time card approval. Initial and on-going training of staff. Serve as a resource to staff for assistance with routine and non-routine problems. Maintain efficient operations by recruiting and retaining competent, motivated staff. Counseling and coaching employees and providing direct and timely performance feedback. Perform all other supervisory functions including, staff orientation, performance evaluations, counseling, corrective action and if necessary, terminations all in accordance with Human Resources policies and procedures.
• Actively work with other department supervisors to ensure accurate and timely coding of services in order to maximize revenue recovery and problem solves issues. Collaborate with department supervisors and staff to update / maintain system master files, directories, letter management. Actively work with other revenue cycle supervisors to get support needed to manage healthconnect system processes, including registration, billing, work queues, electronic billing, letter templates and request system updates and changes. In collaboration with the Sales and Marketing Manager, OH Business Office Manager and OH PCM develop and maintain processes for contract billing / collection which supports competitive pricing and focused customer service. Work with front-end operational managers to problem solve registration and service delivery issues. Perform various periodic audits of the claims / billing and collection practices, evaluating timeliness, accuracy, regulatory compliance. Perform periodic audits evaluating adherence to established process and policy including system(s) understanding and complete documentation. Recommends improvement to workflow, process and system, which optimizes revenue and identifies opportunities for improvement in revenue cycle. Review and approve / deny write-offs and refunds.
• Develop and update department Claims / Billing administration policy and procedures and report organization policy / procedure inconsistencies. Maintain cost effective operations by sustaining high levels of productivity and positive budget variance. Review and approve / deny requests for write-offs and refunds. Negotiate and give final approval for Disputed Claim Settlements working with insurers, attorneys as well as administrative judge protecting Kaisers financial interest in settlement (within limits of expenditure authority). Perform administrative support duties for the MCO as requested. Participate and support UBT development and work in partnership with labor.

Basic Qualifications :

Experience

Education

License, Certification, Registration

Additional Requirements :

Preferred Qualifications :

Notes :