Supervisor, Arbitration - MPOWERHealth

HALOMD

The Supervisor of Arbitration will supervise and coordinate the staff’s daily operations. The Supervisor will have the overall responsibility for mentoring and developing skills of direct reports. The Supervisor will participate in evaluation and implementing quality controls and performance improvement activities.

Essential Job Duties and Responsibilities

• Promote department goals by motivating, coaching, and training team members.
• Train new employees on department policies, procedures, processes, and applicable information systems.
• Lead the activities of assigned team members by communicating and providing guidance toward achieving department objectives.
• Plan and prioritize schedules, assign, and monitor work to optimize operations.
• Analyze claim reports to determine claims eligible for arbitration.
• Ensure all cases are submitted timely.
• Ensure all ineligibility disputes are completed.
• Ensure all informal negotiations and briefs are submitted timely.
• Routinely monitor incoming requests and ensure a timely response.
• Routinely evaluate staff performance, audit work output to ensure compliance with expectations and processes.
• Inform staff of changes in policies, procedures, processes, systems, and regulatory laws and requirements.
• Gather and analyze department metrics and prepare reports for management review.
• Recommend procedural and system changes to improve processes, operational quality, and efficiency, i.e., job aides, training resources, and workflow.
• Meet with director and executive leadership to provide updates of findings and outcomes.
• Actively participate in process improvement projects.
• Work with external vendors such as State Department of Insurance (DOI) personnel and arbitrators to assist with issues and resolutions.
• Maintain attendance, payroll records and processing of time-off requests.
• Handle escalated issues and concerns.
• Monitor urgent action items as needed after office hours and/or weekends.
• Complete special projects.
• Other duties as assigned.

Education and/or Experience

• • High School degree or equivalent
  • Minimum of 3 years medical billing and collections experience.
  • Minimum of 1-year supervisory experience with more than 5 people.

   

  Skills/Specialized Knowledge

   

  • Knowledge of CPT, and ICD-10.
  • Knowledge of legal and regulatory government provisions.
  • Knowledge of laws that regulates communication and privacy act. HIPAA laws and understanding of the application of all above.
  • Strong computer skills including Microsoft Office with a strong proficiency in Excel spread sheets, using formulas, pivot tables, filters, etc.
  • Strong organizational, analytical, and problem-solving skills.
  • Knowledge of the insurance industry.
  • Proven success in negotiation and technical writing.
  • Professionalism in all dealings, both internal and external.
  • Ability to clearly communicate, both verbally and in writing.
  • Knowledge of medical terminology

   

  Other Requirements

   

  • Must maintain professional appearance.
  • Ability to be at work on a regular and consistent basis.
  • Must have and maintain high speed internet that meets or exceeds connectivity requirements when working remotely.
  • Must be available on weekends to respond to urgent action items.

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