Experienced Medical Claims Supervisor – Remote Leadership Position in Physical and Behavioral Health Claims Processing

About Us

At Vaya Health, we are a dynamic and forward-thinking organization dedicated to providing innovative solutions in the healthcare industry. As a leading provider of physical and behavioral health services, we strive to deliver exceptional care to our network of providers and clients. Our team is passionate about making a positive impact in the lives of those we serve, and we are now seeking an experienced Medical Claims Supervisor to join our remote team.

Job Summary

We are seeking an experienced Medical Claims Supervisor to oversee the administration of accounting functions related to physical and behavioral health medical claims processing. As a key member of our team, you will be responsible for ensuring timely and accurate payment to providers, supervising claims staff, and maintaining compliance with established procedures and processes. If you have a strong background in healthcare claims processing, excellent leadership skills, and a passion for delivering exceptional customer service, we encourage you to apply for this exciting opportunity.

Key Responsibilities

As a Medical Claims Supervisor, you will be responsible for the following key areas:

Administrative Supervision and Functions:

+ Oversight of claims staff for claims adjudication activities, providing technical assistance and training as needed + Ensuring claims adjudication policies and procedures are current and up-to-date + Providing support for timely resolution of provider concerns related to claims processing + Supervising claims specialists within the MIS department + Coordinating the recruitment and selection of new claims specialists and recommending new hires + Providing ongoing feedback to staff regarding job performance, performance evaluations, disciplinary action, approving and coordinating leave, coordinating work schedules, signing off and approving timesheets and travel forms + Conducting regularly scheduled staff meetings with all staff reporting to this position

Claims Adjudication:

+ Finalizing claims processed for payment and maintaining claims adjudication workflow, reconciliation, and quality control measures to meet or exceed prompt payment guidelines + Reconciling provider claims payments through quality control measures, generally accepted accounting principles, and Vaya's policies and procedures + Assessing Title XIX and non-Title XIX claims adjustments for correction or recoupment and coordinating the recoupment process to ensure payment is recovered for inappropriately paid claims

Customer Service:

+ Maintaining provider satisfaction by managing provider inquiries, providing information, and assistance + Assisting providers in resolving problem claims and system training issues + Serving as a resource for internal staff to resolve eligibility issues, authorization, overpayments, recoupment, or other provider issues related to claims payment + Coverage of specific functions to assist the Department as work demands may dictate

Compliance and Quality Assurance:

+ Reviewing internal bulletins, forms, manuals, and applicable revisions, and fee schedules to ensure compliance with established procedures and processes + Attending and participating in workshops and training sessions to improve technical competence

Essential Qualifications and Education Requirements

To be considered for this role, you must possess the following qualifications and education requirements:

• High school diploma or GED required
• Associate degree in business administration, health administration, communications, or a related field preferred
• A high school diploma or GED and four years' experience in healthcare processing medical claims/reimbursement with experience in Physical Health and/or Behavioral Health claims is required and one year supervisory/coordination experience in behavioral health, medical billing/coding, or similar
• OR Associate Degree and one year experience in claims/reimbursement and one year supervisory/coordination experience in behavioral health, medical billing/coding, or similar
• OR Bachelor's Degree and one year supervisory/coordination experience in behavioral health, medical billing/coding, or similar

Skills and Competencies Required for Success

To excel in this role, you will need to possess the following skills and competencies:

• Working knowledge of the Medicaid Waiver requirements, HCPCS, revenue codes, ICD-9/10, CMS-1500/UB-04 coding, compliance, and software requirements used to adjudicate physical and behavioral health medical claims
• Ability to handle a large volume of work and manage a desk with multiple priorities
• Ability to work in a team atmosphere and in cooperation with others and be accountable for results
• Ability to maintain confidential information
• Ability to establish appropriate and respectful relationships/partnerships with providers served
• Ability to work with a multi-disciplinary team approach
• Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules
• Strong organization skills, computer proficiency, including Microsoft Office
• Ability to speak and write professionally
• Ability to understand oral and written instructions
• General knowledge of office procedures and methods

Career Growth Opportunities and Learning Benefits

As a Medical Claims Supervisor at Vaya Health, you will have the opportunity to:

• Develop your leadership skills and experience in a dynamic and fast-paced environment
• Expand your knowledge and expertise in healthcare claims processing and compliance
• Collaborate with a talented team of professionals who share your passion for delivering exceptional care
• Participate in ongoing training and professional development opportunities to enhance your skills and competencies
• Enjoy a competitive salary and benefits package, including opportunities for career growth and advancement

Work Environment and Company Culture Highlights

As a remote employee, you will have the flexibility to work from the comfort of your own home, while still being an integral part of our team. Our company culture values:

• Collaboration and teamwork
• Innovation and creativity
• Excellence and quality in all that we do
• Respect and empathy for our clients and colleagues
• Continuous learning and professional development

Compensation, Perks, and Benefits

We offer a competitive salary and benefits package, including:

• A competitive salary based on qualifications and experience
• Opportunities for career growth and advancement
• Comprehensive benefits package, including medical, dental, and vision insurance
• 401(k) retirement plan with company match
• Paid time off and holidays
• Professional development opportunities and training

How to Apply

If you are a motivated and experienced Medical Claims Supervisor looking for a new challenge, we encourage you to apply now! Please submit your application through our Career Center at [https://www.vayahealth.com/about/careers/](https://www.vayahealth.com/about/careers/). We look forward to reviewing your application and discussing this exciting opportunity with you further. Apply for this job