Children's Care Manager

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

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