JOB SUMMARY: Supervise and mentor the claims staff to achieve production, quality and turn around goals as set by Community Health Choice (CHC). Responsibilities include reviewing the Texas Medicaid Banner and Bulletin messages. Work closely with the claims departments to ensure that any additions or revisions identified in the banners and bulletins are communicated to the claims staff.

Job Reponsibilities:

• 30% Oversee and manage claims staff. Facilitate team meetings
• 20% Mentor and train Team Leads. Train claim examiners where problem areas are identified through audit results.
• 20% Medicaid Bulletin updates and communication
• 20% Work with Provider Relations team to identify provider issues.
• 10% Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans.
• Other duties as assigned

MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure:

• High School Graduate or GED equivalent

Work Experience (Years and Area):

• Minimum 10 years experience claims adjudication, preferably 2 years in Public Sector line of business

Management Experience (Years and Area):

• Minimum 1 year

Equipment Operated:

• PC, 10 key skills, medical coding, CPT and HCPCS coding.

SPECIAL REQUIREMENTS:
Communication Skills:
Above Average Verbal (Heavy Public Contact)

• Writing /Composing Correspondence / Reports

Other Skills:

• Analytical, Medical Terms, Research

Work Schedule: Flexible


RESPONSIBLE TO:
Manager , Director, Vice President

EMPLOYEES SUPERVISED:
Highest Level: Claim Examiners, Team Leads, Clerical Staff