Senior Claims & Revenue Cycle Supervisor

Provider Network Solutions, LLC; Miami (FL); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Provider Network Solutions, LLC in Miami is seeking a Claims and Revenue Cycle Supervisor to lead the Claims Examiners team, ensuring accurate processing of capitated and fee-for-service claims and compliance with CMS/state regulations.

The role requires strong leadership, analytical skills, and experience with ICD-10/CPT coding and revenue cycle systems, with a focus on process improvement and collaboration with providers.

Qualifications

• Bachelor’s degree in health administration, business, or a related field.
• 5+ years in healthcare claims processing or revenue cycle, with 2+ years supervising.
• Strong knowledge of CMS, Medicare, Medicaid, HIPAA and healthcare compliance.
• Experience with ICD-10, CPT/HCPCS coding and claims adjudication platforms.

Responsibilities

• Oversee daily activities and staff of the Claims Examiners processing capitated and Fee-for-Service claims.
• Monitor revenue cycle operations, run reports, ensure timely, accurate processing and 835 postings.
• Develop and enforce claims policies and procedures to ensure CMS and health plan compliance.
• Investigate overpayments/underpayments and resolve disputes.
• Collaborate with Provider Servicing and educate providers as needed.
• Maintain understanding of benefits, coding, reimbursement policies, and contracts.

Skills

Analytical

Leadership

Communication

Policy Development

RCM Systems

Education

Bachelor's degree in health administration, business, or related field

Job description

Provider Network Solutions, LLC in Miami is seeking a Claims and Revenue Cycle Supervisor to lead the Claims Examiners team, ensuring accurate processing of capitated and fee-for-service claims and compliance with CMS/state regulations.

The role requires strong leadership, analytical skills, and experience with ICD-10/CPT coding and revenue cycle systems, with a focus on process improvement and collaboration with providers.