Supervisor, Reconciliation

American Specialty Health, Inc. is seeking a Supervisor, Reconciliation to join our Reconciliation department. This position will supervise OPS Reconciliation personnel and oversee claims reconciliation and/or related tasks to meet deadlines. Related tasks may include quality assurance and audit support. The Reconciliation Supervisor will ensure accuracy through identification of training needs and subsequent execution and by monitoring the research and resolution of claims issues and errors. 

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Responsibilities

  • Develops spirit of cooperation and understanding among all departmental staff.
  • Trains, develops staff members.
  • Monitors and documents subordinates’ performance; provides timely feedback, coaches, counsels and disciplines; composes and delivers performance appraisals.
  • Assigns work to staff members to ensure contractual and regulatory deadlines are met.
  • Oversees daily operations, by running and monitoring daily and weekly status reports for reconciliation claims functions by dates for inventory volumes, and team production.
  • Informs Leadership of urgent issues, priorities, identified problems and associated recommendations of/for subordinates’ performance.
  • Participates in the hiring/termination process.
  • Recommends efficiencies and system improvements.
  • Facilitates monthly team meetings; prepares agenda and minutes for those meetings.
  • Supports department performance standards and quality improvement processes.
  • Develops and maintains Reconciliation Policies and Procedures.
  • Monitors staff to ensure understanding of and compliance with organizational policies and procedures.
  • Responsible for: recognizing unique and/or problem situations, researching and formulating solutions.
  • Works with IT to accurately develop or enhance reports.
  • Maintains confidentiality of all members, providers, clients and other proprietary and sensitive business information.
  • Ensures claims compliance with regulatory agencies, accreditation agencies and health plan delegation requirements.
  • Performs pre-audits on 2 step reconciliation and report findings to Sr. Manager.
  • Researches audit findings and provides general assistance for Health Plan, or other regulatory agency audits.

Qualifications

  • AA degree or equivalent experience preferred.  If equivalent experience, high school diploma required.
  • Production environment knowledge/experience required.
  • Minimum of two years of experience in a managed care claims department preferred, with at least one year as a claims examiner and one year as a senior examiner, claims analyst, claims auditor or claims supervisor. 
  • Three years computer experience including automated claims systems, Microsoft Office (Word, Excel, Outlook), 10-key and typing skills.
  • Minimum of one-year supervisory experience or leadership capacity.
  • Strong knowledge of CMS 1500 claim requirements, CPT codes, ICD codes and medical terminology preferred.
  • Familiarity with Managed Care, HMO, PPO health plan provisions.
  • Strong analytical, problem solving, verbal and written communication skills.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

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Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. 

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH 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 Company’s legal duty to furnish information.