Supervisor/Team Lead, Content Ideation and Configuration

JOB SUMMARY

This role ensures timely, accurate processing of all aspects of the identification, investigation, and validation processes for Payment and Revenue Integrity products. The position monitors, prioritizes and distributes work to assigned team(s). The incumbent will work to facilitate quality processing of cases according to policy and procedures and client service level agreements (SLA's). This individual will work to identify recoveries for assigned clients that meet or exceed forecasts and partnering with senior leadership to execute on short and long term production strategies.

JOB ROLES AND RESPONSIBILITIES

1. Schedules and prioritizes work, approve time off, conducts performance reviews, hires, and trains new employees, and performs other supervisory responsibilities and enforces production, quality, and customer-service standards / SLAs. Addresses issues with the team as a whole and individually.
2. Set employee performance standards, develop and monitor departmental key performance indicators (KPIs). Communicate department performance to senior management. Identify and assign training needs on an individual basis. Provide continuous coaching of the staff so they perform at the highest levels.
3. Meet with direct reports to assess their performance and progress against expectations. Write and communicate performance reviews.
4. Primary point of contact for offshore contractors, including but not limited to the following: hiring for correct skillset, work assignment, approving hours, coordinating training, mitigating vendor specific issues, and working with vendor management to drive acceptable results.
5. Routinely utilizes expertise specific to coordination of benefits rules, regulations, methodologies, and audit tactics to ensure efficient day-to-day operation of the department.
6. Ensures compliance with CMS, NAIC and state COB guidelines. Ensures team is following company and client expectations.
7. Works closely with senior leadership to document policies, procedures, and processes. Maintains and improves COB/OHI processes by monitoring trends and addressing issues for process improvement.
8. Must maintain a high level of confidentiality in dealing with protected health information and ensure that teams do the same.
9. Fields client issues and complaints and decides on a course of action to resolve the matters.
10. Select, develop, and evaluate staff to ensure the efficient operation of department.
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company's Core Competencies and values held within.
14. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role.
15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE

This role works under limited supervision in the execution of the positions day-to-day responsibilities. This role will be a key contact in drafting, implementation and maintenance of policies and procedures specific to the department. The incumbent will have a sizeable amount of influence on departmental revenue figures through the provision of effective mentorship of more junior team members. This is a people management job with authority for all HR actions (hiring, firing, discipline, training, etc.) as well as assign work and coordinate the work of offshore resources.

JOB REQUIREMENTS (Education, Experience, and Training)

• Minimum high school diploma plus five (5) years experience in healthcare/insurance operations, coordination of benefits/Medicare Secondary Payor/ESRD Premium Restoration, or claims processing environment; two (2) years' of which should be inclusive of supervisory or other leadership experience.
• History of demonstrated client focus and ability to achieve results.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Good organizational, analytical and independent decision making skills.
• Strong problem solving skills with the ability to manage multiple priorities and meet associated timelines.
• Proficient with MS Office products including Microsoft Excel.
• Specifications should support the essential functions identified in the job, assuring compliance with the Americans with Disabilities Act (ADA) and other such employment-related acts (i.e., ability to stand for long periods of time, ability to interact with customers or visitors, ability to lift up to 50 pounds, ability to travel).
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

COMPENSATION

The salary range for this position is $65-70 annually Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

LI#AN1

Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.