Claims Denials Supervisor- MDLIVE

Cigna; Chicago (IL); Remote; USD 53,000 - 89,000; Full time

Job summary

An innovative healthcare company is seeking a Denials Supervisor to lead a dynamic team in managing denial-related revenue. This role involves training and mentoring staff, analyzing claims data, and implementing effective procedures to minimize denials. The ideal candidate will have a strong background in Telehealth and a passion for improving healthcare access. Join a forward-thinking organization that values creativity and teamwork, offering a supportive environment where your contributions can make a real difference in the lives of patients. This is your chance to be part of a mission-driven team dedicated to enhancing healthcare quality and accessibility.

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

401(k) with Match

Paid Time Off

Tuition Reimbursement

Paid Life Insurance

Qualifications

• 5+ years of experience in denials, particularly in Telehealth and Behavioral Health.
• Minimum of 2 years front and back-office experience required.

Responsibilities

• Monitor denial-related revenue and track claims rejected by payers.
• Engage cross-functionally to resolve client claim issues.

Skills

Claims Cycle Knowledge

Problem-Solving Ability

Communication Skills

Data Analysis

Education

Associate's/Bachelor's Degree

Tools

Athena

Excel

Salesforce

Outlook

Job description

POSITION SUMMARY

Expanding access to affordable, high-quality healthcare starts at MDLIVE. We foster innovative ideas in healthcare daily. The Denials Supervisor is responsible for monitoring all denial-related aging revenue by reviewing, trending, and tracking claims rejected or denied by system edits or payers. This role supports 10+ direct reports through ongoing training, mentoring, and establishing appropriate KPIs.

ESSENTIAL FUNCTIONS

1. Engages cross-functionally to resolve client claim issues.
2. Assists with physician queries and interacts with credentialing staff as required.
3. Follows ICD-10-CM, CPT, HCPCS, AMA CPT Guidelines, and CMS directives related to denials and appeals.
4. Pursues collection activities to secure reimbursement from payers or patients.
5. Follows up frequently on outstanding accounts with payers or patients.
6. Sets daily standards for the denials team.
7. Assigns claims to team via Athena worklist.
8. Generates reports and coaches team members to meet goals.
9. Develops and implements coding RCM procedures, analyzes current processes, recommends changes, and creates SOPs.
10. Researches and interprets data to answer internal/external client questions.
11. Maintains denials-related Jira tickets within 30 days.
12. Monitors and develops action plans to reduce denials and rejections.
13. Works cross-functionally to resolve claim issues.
14. Must be able to read and interpret payer/client contracts.
15. Manages payer projects with tight timelines.
16. Demonstrates problem-solving ability and sound judgment.
17. Participates in educational opportunities to update job knowledge.

QUALIFICATIONS

• Associate's/Bachelor's degree preferred or equivalent experience.
• 5+ years of denials experience in Telehealth, Urgent Care, Primary Care, Wellness, Behavioral Health, Dermatology preferred.
• 5+ years of supervisory or managerial experience preferred.
• Minimum of 2 years front and back-office experience.
• Working knowledge of payer implementations.
• Proficiency in Athena, Excel (including pivot tables), Outlook, Salesforce.
• Understanding of Health Insurance EOBs, denials, and appeals.
• Ability to meet deadlines.
• Strong claims cycle knowledge.

For remote work, internet must be broadband or fiber optic with at least 10Mbps download and 5Mbps upload speeds. The annual salary range is $53,300 - $88,900, depending on experience and location, with potential eligibility for an annual bonus.

We offer comprehensive benefits including medical, vision, dental, well-being programs, 401(k) with match, paid life insurance, tuition reimbursement, at least 18 days paid time off, and paid holidays. More info at Life at Cigna Group.

About Evernorth Health Services

Evernorth, a division of The Cigna Group, develops pharmacy, care, and benefit solutions to improve health and vitality, aiming to make illness prediction, prevention, and treatment more accessible. Join us to drive growth and improve lives.

We consider all qualified applicants regardless of race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran status, religion, national origin, and other protected characteristics.

For accommodations during application, email [e-mail]. Do not send resumes or application updates to this email.

The Cigna Group maintains a tobacco-free policy and may not hire tobacco/nicotine users in certain states unless they participate in a cessation program. Consideration will be given to applicants with criminal histories in accordance with applicable laws.