Claims Supervisor - Harris Health System

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

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