Supervisor, EDI Claims

Job Description Reporting to the Manager, HIT Operations, the Supervisor, EDI Claims is responsible for the supervision of all day-to-day activities of the EDI Claims team, including but not limited to providing direction; monitoring teammate (TM) performance; and improvement of workflows and processes. The EDI Claims team is responsible for acknowledging, processing, and ensuring that all claims received are posted timely and accurately in the EZ-CAP system. Duties and Responsibilities Manage and provide direction to ensure all electronics claims files are processed timely. Ensure all files are received according to expected timelines and escape issues when needed. Provide support to resolve processing or data issues and escape issues when needed. Support the programming of required logic and implementation of tools, systems, and applications used for the loading of claims into EZ-CAP. Develop and maintain productivity and reconciliation reports, including but not limited to inbound electronic claims volume and data accuracy reports. Facilitate the development, review, and revision of team policies, procedures, and workflow diagrams. Collaborate effectively with internal and external stakeholders to ensure the smooth execution of team functions, including but not limited to the Claims Operations department. Collaborate with HIT leadership to develop benchmark measures that evaluate work productivity and quality. Review and analyze the effectiveness and efficiency of existing processes and develop strategies for improvement. Ensure that complex claims EDI issues are resolved within established guidelines. Serve as technical and informational resource for all TMs, facilitating TM training and mentorship. Evaluate work assignments in support of efficient file processing. Respond to escalated questions and/or issues brought up by the team. Monitor and manage TM time, overtime, and scheduling. Develop new EDI solutions for business operations as needed to remain compliant with regulatory requirements. Other job responsibilities as assigned. Minimum Job Requirements Strong knowledge of HIPAA ANSI 834, 270, and 271 format(s) and Health Plan proprietary formats. Bachelor’s degree or 4+ years equivalent work experience in a similar role. Ability to navigate EZ-CAP, Tableau, and Smartsheet. Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote). Skill and Abilities Strong organizational skills, with the ability to manage several projects and priorities at the same time. Ability to work effectively with all levels of the organizations and stakeholders, including health plans and clients. Positive attitude and flexible, a must. The ability to take initiative while remaining open to the ideas of others. Strong communication, analytical, coaching/mentoring, and team building skills. Ability to troubleshoot problems and recommend, develop, and implement effective improvements. Ability to use sound judgment in completing tasks and to seek guidance when needed. #J-18808-Ljbffr 6AM City, LLC