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Resolutions and Adjustments, Supervisor - Tallahassee, United States - CNSI
Description
** Resolutions and Adjustments, Supervisor**
**Job Category****:** Adjustment and Resolutions **Requisition Number****:** RESOL002301 Showing 1 location **Job Details**
**Description**
***Resolution and Adjustment Supervisor***
The Resolution and Adjustment Supervisor manages resolution and adjustment specialists that conduct bill-specific research to resolve outstanding issues. The Resolution and Adjustment Supervisor provides guidance to specialists in a variety of duties.
***Job Responsibilities:***
Research bill issues to identify root causes and determining corrective actions to resolve issues, communicating findings, and documenting findings for future use.
Request additional information needed to complete adjudication of bills.
Review bills for necessity, limitations, and exclusions based on bill policies and procedures.
Assist internal associates with bill-related questions and issues.
Identify reoccurring problems and providing feedback to management to affect change.
Make the appropriate payment adjustment into the claims system
Complete data entry for tracking and reporting of claim disputes
Adjudicate claims and adjustments that are identified as sensitive
Act as a trouble-shooter to resolve claim processing problems among internal departments, including authorization issues
Assist in providing daily guidance for associates to obtain optimal results and to ensure all SLA and timeliness standard are met
Handle all types of requests, inquiries and complaints accurately and timely
Monitor team members daily productivity goals and provide feedback where necessary
Provide re-enforcement training for new and existing associates as needed
Help identify system/benefit errors completing protocols and workflows to prevent future errors
Provide re-enforcement training for new and existing associates as needed
Complete performance reviews and staff coaching
Provide ongoing training with staff
Ensure Medical Terminology course is completed by all staff members
***Experience/Preferred Skills Required:***
Must have a BS/BA degree in Healthcare, Business, or other related scientific or technical discipline, with recent experience of at least Five (5) years in medical bill processing or similar environment
Three (3) years of that experience in Resolution and Adjustment conducting bill-specific research to resolve outstanding issues (may overlap with other experience)
One (1) year of that experience in a leadership role managing resolution and adjustment specialists that conduct bill-specific research to resolve outstanding issues (may overlap with other experience
OR, High School or GED equivalent diploma, with recent experience of at least: eight (8) years in medical bill processing or similar environment
Five (5) years of that experience in Resolution and Adjustment, conducting bill-specific research to resolve outstanding issues
General knowledge of Workers compensation and medical terminology
Familiarity with medical bill forms, ICD-9/10CM coding, CPT coding, bill forms, and other medical coding schemes (certificate desired).
Ability to simultaneously maneuver through various computer claims and eligibility platforms while verifying information while on the telephone
At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. Were passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.
Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun You will be offered a competitive compensation and benefits package.
CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status or any other status protected by applicable Federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.
*In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States, and to complete the required employment eligibility verification at time of hire or transfer. CNSI will not sponsor new employment visa petitions.*
**Qualifications**
**Skills**
**Behaviors**
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**Motivations**
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**Education**
**Experience**
**Licenses & Certifications**
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR c)
