Claims Director - New York, NY, United States - MetroPlus

Description

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.

As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics.

For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Claims Supervisor is responsible for the daily oversight of claims processes including but not limited to the inquiry and resolution process, adjudication process, user acceptance testing and quality assurance, training, and reporting.

In addition, the position assists the claims manager with claims related queue management (i.e. claims, inquiries, refunds, adjudications) to ensure that inventory is processed accurately and in a timely manner. The Claims Supervisor will also provide daily management and oversite of the claims operation staff.

Job Description

Liaises between claims staff and stakeholders, including providers, members, and internal MetroPlusHealth staff.
Participates in claims related workgroups designed to address claims issues and improve processes.
Prepares routine reports for the manager on productivity, error rates, complaint rates, financial recordkeeping, and other activities.
Identifies system processing issues and assist with the root cause analysis process.
Develops, implements, and maintains claims operation policies, procedures and workflow.
Assists with the planning, development, and training of claims operations staff.
Provides input related to the development and performance of employees to Manager.
Manages daily inventory queues and assigns resources to ensure inventory is processed timely and accurately.
Monitors daily inventory and assigned claims queues for production and issue identification.
Generates claims operations dashboard and reports related to inventory and productivity.
Participates in special projects as needed.
Other duties as assigned.

Minimum Qualifications

Bachelor's degree required
Minimum 3-5 years of claims operations experience in a healthcare field required
Minimum 1 year of claims supervisory-related experience highly preferred
Knowledge of claims payment methodologies and policies.
Proficient in reporting applications, such as Excel, Access or SQL preferred.

Professional Competencies

Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication
Ability to work in a dynamic and fast paced environment.

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