Supervisor, Medicaid Claims Reviewer - Remote

Overview

The Supervisor, Medicaid Claims Reviewer oversees a team responsible for assessing healthcare claims for accuracy and compliance, ensuring efficient processing in accordance with industry standards.

In Short

• Supervise a team of Medicaid Claims Reviewers.
• Manage claims inventory and identify adjudication errors.
• Conduct high-dollar reviews and note claims denial trends.
• Coach and mentor team members.
• Collaborate with other departments to improve claims processing.
• Analyze claims data for trends and process improvements.
• Provide training on industry changes and standards.
• Ensure accuracy in claims documentation.
• Stay updated on billing guidelines and reimbursement rules.
• Conduct audits to verify compliance with regulations.

Requirements

• Bachelor's degree required (experience can be considered in lieu of degree).
• Certified Professional Coder (CPC) preferred.
• 3-5 years of experience in healthcare claims review or processing.
• 1-2 years in a senior or leadership role.
• Strong knowledge of healthcare claims processes and coding (CPT, ICD-10).
• Excellent leadership and communication skills.
• Proficiency in claims processing software.
• Strong attention to detail.
• Ability to manage multiple tasks and priorities.

Benefits

• Competitive base pay with comprehensive benefits.
• Career advancement opportunities.
• Differentials, premiums, and bonuses as applicable.
• Recognition programs to celebrate contributions.