Responsibilities

Responsible for the supervision of Commercial claims adjudication.  Essential job functions include ensure that quality and productivity standards are achieved.   Create daily work plans specific to inventory objectives.  Work collaboratively with leaders to develop training and in-service initiatives. Oversee all quality improvement initiatives for Claims unit. Oversee the Provider Service Unit to ensure that service objectives are met.  Identify provider-billing issues via claims service trends and communicate to Sr. Contract Manager for provider education.  Supervise auditing activities and evaluate trends.  Supervision of Resolute to Tapestry commercial claims. Supervision of Health Plan Claim Delegation agreements including annual audits, resolution of corrective action plans, and submission of statistical reports (monthly, quarterly, and annually). Provide Resolute to Tapestry claims support.   Lead COB/Recovery tasks including analysis and reporting and recoupment initiatives.  Supervision of auto-adjudication activity.

Maintain applicable policies/procedures, coordinate staffs’ participation in testing as needed.   Create and distribute operational reports.   Exhibit leadership qualities through performance, appearance and demeanor.  Responsible for employee relations tasks including development and coaching and other duties as assigned.    

 

Job Title: Supervisor, Managed Care Claims

Location: Pearland Administrative Office

Department: Claims

Job Type: Full Time 

Salary Range: $64,369 - $79,496 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

 

Qualifications

Education

Required: Associates Degree or equivalent experience (1to 1)

Preferred: Bachelor’s Degree

Experience

Required: 5 years of working experience in a Managed Care environment as Senior Analyst, Coordinator, 

 

OR 

 

Supervisor or Advance Degree with 3-5 years’ experience

 

Extensive knowledge of reimbursement methodologies specific to Facility and Professional Claims. 

 

Report development experience (I.e. Citrix, Crystal, etc.).

 

Proficient use of Microsoft products including word, excel, and power point

 

Claims Quality Experience

 

CMS & TDI industry guidelines

 

Excellent communication skills

 

Knowledge of COB/Recovery Procedures

Preferred: EPIC Systems Experience       

License(s)

Required: N/A

Preferred: Professional appearance.

Special Skills

Required: Must be self-directed, flexible, detail oriented and able to absorb information quickly. 

 

Works well under pressure in a fast-paced environment. 

 

Demonstrated ability to motivate employees in a claims production environment

Preferred: Ability to work with minimum supervision

Other 

Required: N/A

Preferred: N/A

 

Working Environment: Office

 

About Us

Start your career journey and become a part of a community of renowned Healthcare professionals.  Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties.  Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner.  Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares. 

 

Why Kelsey-Seybold Clinic?

Medical, Vision, and Dental Tuition Reimbursement Company Matching 401K Employee Reward and Recognition Program Paid time off for vacation, sick, and holidays Employee Assistance Program Continuing Medical Education allowance