Claims Quality & Training Supervisor
Location: Pearland Administrative Office
Job Type: Full-time
Kelsey-Seybold Clinic. Your Doctors for Life.
Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 19 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.
The Quality & Training Supervisor will work collaboratively with claims leaders & staff to foster and sustain a Quality and Training program including multiple trajectories associated with Commercial and Medicare Advantage claims adjudication procedures, address the training needs for Claims Quality Support, Provider Services, Clerical Support, and Coordination of Benefits/Recovery business units. Develop and utilize approved training courses, materials, departmental policies and procedures to effectuate successful outcomes. Schedule training activities, Oversee the efforts of the Claims Appeals and Adjustment Unit and Quality Assurance Unit; utilize audit results, appeals & adjustment trends and reporting data to improve overall quality outcomes relative to claims adjudication decisions. Exhibit leadership qualities through performance, appearance and demeanor. Responsible for employee relations including development, counseling and other duties as assigned. This position will supervise 6 employees within the department.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
Bachelor’s degree in technical or business area or 2 years equivalent work experience for each year of college.
Minimum 5 years work experience in Healthcare Claims Operations environment.
2 years of Epic Tapestry experience.
3 years of training experience with Facility and Professional Claims Adjudication.
Kelsey-Seybold work experience. Previous work experience with EPIC Tapestry, CodeReview, Virtual Examiner, CCE Pricer; CMS or 3M Pricing Software
Technical Experience helpful
Demonstrated understanding of medical claims payment procedures.
Demonstrated use of Claims Pricing Software (CMS and Industry.)
Demonstrated understanding of how benefits and provider/vendor configuration is integrated with payment/denial processes.
Excellent interpersonal skills,
The ability to present complex information and effectuate favorable student learning.
Excellent communication skills.
Demonstrated flexibility as a member of a multifunctional team in a fast paced environment.
Must be self-directed, flexible, detail oriented and able to absorb information quickly. Works well under pressure in a fast pace environment. Demonstrated ability to motivate employees in a claims production environmentsupplies.
Ability to work with minimum supervision
Demonstrated proficiency in Microsoft Office.