Supervisor, Hospital Claims

1199SEIU Benefit and Pension Funds; New York (NY); Hybrid; USD 116,000 - 140,000; Full time

Job summary

A leading organization in health benefits is seeking a Supervisor for Hospital Claims. This role involves overseeing staff, ensuring compliance with guidelines, and optimizing claims workflows. Candidates should have a degree in health administration, solid experience in claims processing, and strong leadership skills.

Qualifications

• Minimum of three (3) years’ hospital claims processing experience required.
• Knowledge of CPT, ICD-10, HCPCS, and hospital reimbursement methodologies.
• One (1) year leadership experience required.

Responsibilities

• Supervise front-end Processor unit staff in claims processing.
• Monitor daily work queue distribution and completion.
• Prepare reports on unit inventory, activities, and production.

Skills

Analytical skills

Leadership skills

Communication skills

Education

Bachelor’s Degree in Health Administration

Tools

Microsoft Word

Microsoft Excel

Job description

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• Supervise the National Benefit Fund (NBF) Hospital Claims front-end Processor/clerical unit staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement
• Provide support to the unit’s Manager and Assistant Manager in optimizing workflows, distribution and review of work; response to audits, and monitoring of claims production/inventory
• Ensure timely distribution and processing of claims through the Document Management System (DMS) and QNXT Pend Workflow, and of QNXT Call Tracking; resolve DMS-QNXT discrepancies
• Ensure claims/correspondence are finalized in accordance with member benefitand eligibility parameters; Summary Plan Description provisions; Coordination of Benefits (COB) guidelines; regulatory and pre-authorization requirements; Claim Checkand Medicare National Correct Coding Initiative (NCCI) rules; provider/repricing network contract terms and timeframes; and Fund/departmental policies
• Monitor daily QNXT reports, work queue distribution/completion in the Document Management System (DMS), QNXT Pend Workflow, and QNXT Call Tracking systems
• Review and assess staffmember’s performance with regard to quality/ productivity standards, audit results, and Health Insurance Portability and Accountability Act (HIPAA)/Compliance rules; provide audit rebuttal responses; meet regularly with staff to provide feedback/coaching; develop plans for additional training to remedy shortcomings; take correction action when necessary, to ensure the staff meet departmental/Fund requirements
• Process high dollar claims at the Supervisor level; serve as back-up to Manager/Assistant Manager in their absence to ensure operational activities are achieved and projects are completed
• Monitor timely workflow turnaround of documentation between the clerical staff and the Eligibility/COB and Provider Relations/Balance Billing Departments, to support claims finalization
• Prepare weekly and monthly reports on unit inventory, activities, production, and progress
• Prepare and maintain attendance/ lateness records and weekly timesheets for payroll to ensure compliance with Funds’ policy and procedures
• Coordinate t esting of QNXT claims processing system in preparation of system enhancements/contract changes, and report/track issues
• Perform special projects and assignment as assigned by management
  
  

Requisition #:

7276

# of openings:

1

Employment Type

Full time

Position Status

Permanent

Category

Non-Bargaining

Workplace Arrangement

Hybrid

Fund

1199SEIU National Benefit Fund

Job Classification

Exempt

Responsibilities

• Supervise the National Benefit Fund (NBF) Hospital Claims front-end Processor/clerical unit staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement
• Provide support to the unit’s Manager and Assistant Manager in optimizing workflows, distribution and review of work; response to audits, and monitoring of claims production/inventory
• Ensure timely distribution and processing of claims through the Document Management System (DMS) and QNXT Pend Workflow, and of QNXT Call Tracking; resolve DMS-QNXT discrepancies
• Ensure claims/correspondence are finalized in accordance with member benefitand eligibility parameters; Summary Plan Description provisions; Coordination of Benefits (COB) guidelines; regulatory and pre-authorization requirements; Claim Checkand Medicare National Correct Coding Initiative (NCCI) rules; provider/repricing network contract terms and timeframes; and Fund/departmental policies
• Monitor daily QNXT reports, work queue distribution/completion in the Document Management System (DMS), QNXT Pend Workflow, and QNXT Call Tracking systems
• Review and assess staffmember’s performance with regard to quality/ productivity standards, audit results, and Health Insurance Portability and Accountability Act (HIPAA)/Compliance rules; provide audit rebuttal responses; meet regularly with staff to provide feedback/coaching; develop plans for additional training to remedy shortcomings; take correction action when necessary, to ensure the staff meet departmental/Fund requirements
• Process high dollar claims at the Supervisor level; serve as back-up to Manager/Assistant Manager in their absence to ensure operational activities are achieved and projects are completed
• Monitor timely workflow turnaround of documentation between the clerical staff and the Eligibility/COB and Provider Relations/Balance Billing Departments, to support claims finalization
• Prepare weekly and monthly reports on unit inventory, activities, production, and progress
• Prepare and maintain attendance/ lateness records and weekly timesheets for payroll to ensure compliance with Funds’ policy and procedures
• Coordinate t esting of QNXT claims processing system in preparation of system enhancements/contract changes, and report/track issues
• Perform special projects and assignment as assigned by management
  
  

Qualifications

• Bachelor’s Degree in Health Administration or equivalent years of work experience
• Minimum of three (3) years’ hospital claims processing or health claims Quality Control Reviewer/Auditor experience required; to include one (1) year leadership role required
• Basic knowledge of basic Microsoft Word and Excel preferred
• Strong knowledge of CPT, ICD-10, HCPCS, UB-04, hospital reimbursement methodologies and contracts
• Knowledge of eligibility, medical terminology, third-party reimbursement; COB; basic Microsoft Word/Excel
• Strong analytical, critical thinking, interpersonal and communication skills (written and oral)
• Good leadership skills and ability to direct and motivate staff
• Excellent organizational skills; able to multi-task, work well under pressure, prioritize and follow-up

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Manufacturing

• Industries

  Hospitals and Health Care

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