Supervisor, Coding & Claims Resolution Analysts

Job Description

Job Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Supervisor of the Coding Analysts and Claim Resolution Analysts within Operations is responsible for the Coding and Claim Teams, and providing oversight and management of issue resolution for Medica’s members and providers across all business/products. The Coding Analysts and Claim Resolution Analysts support the timely resolution of issues received from Medica’s Customer Service (members/providers – all products) and issues received directly from Medica’s key providers and leased provider networks. The supervisor is responsible for managing the team’s performance and meeting our customers’ expectations for turn-around-time. The supervisor works toward root cause analysis by partnering with internal and external (vendor) partners. The supervisor supports internal customers and works with both internal and external vendor partners. Performs other duties as assigned. 

Key Accountabilities: 

Problem Solving, Escalated Issue Management, Relationship Management and Issue Resolution

• Leverages knowledge of all Medica products, policies and processes. Accurately interprets member and provider contracts and follows Medica’s procedures
• Identifies processing errors or claim payment trends, accurately identifies the source and root cause of problems
• Identifies inappropriate coding trends, claim processing trends, and system set up issues that result in errors and engages the appropriate players as necessary to develop a plan to resolve the trends
• Identifies trends by analyzing complex operational issues and reviewing provider contracts, files, systems, policies and procedures to formulate clear picture of the situation, identifying cause and effects
• Proactively communicates to providers, members, and internal customers within an appropriate time frame. Documents all provider and other applicable issues in ePIL database following the established business rules. Utilizes all software applications needed to adequately research and resolve claim issues (i.e. IDRS, ISET, Info Reports, COSMOS, Health Rules, etc.)

Team and Staff Performance Management

• Supervises staff, sets objectives, coaches and develops, provides feedback and conducts annual performance reviews
• Holds regular staff meetings/huddles and 1:1 meetings
• Manages staffing, training, scheduling, and team morale
• Promotes a positive working climate that supports open and honest communication, integrity, service quality, and innovation and is achievement-focused
• Manages performance and holds staff accountable for meeting department standards. Formulates action plans for less than acceptable performance

Project Management

• Contacts and coordinates resources (other departments, vendor partners, providers) to resolve identified operational issues in an effective and timely manner
• Coordinates data from provider, Siebel/Oracle reports, and customized reports to identify accurate data for claims projects
• Monitors claims project status progress and communicates progress to various stakeholders (providers, network management, upper management, customer service operations, etc.) Documents project status and resolution in ePIL as required
• Effectively manages many projects simultaneously, plans and executes special projects as requested by management
• Assists with companywide initiatives or changes
• Leads communication to key strategic providers

Required Qualifications: 

• Bachelor's degree or equivalent experience in related field
• 5+ years of work experience beyond degree in coding 
• 1+ years of coding team leadership experience 

Preferred Qualifications: 

• Prior claims operations experience in a health plan setting
• Demonstrated problem solving skills including root cause analysis 
• Ability to collaborate effectively with cross-functional partners including with external partners 

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE. 

The full salary grade for this position is $62,700 - $107,500. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $62,700 - $94,080. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. 

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.