Appeals Supervisor

Appeals Supervisor

The Appeals (Provider Relations) Supervisor is responsible for daily operations within the Provider Relations department. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests along with appeal submissions. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Manage team performance by setting and communicating standards and deadlines, measuring results, and providing feedback; maintain positive morale by leading through example and accountability with a focus on helping each member achieve their best performance
• Assist leadership in obtaining complex information from various financial, clinical, and operational systems and data sources
• Assist with pricing of claims according to provider contracts
• Guide team with problem solving regarding customer complaints, or inquiries, including bill review disputes
• Identify, quantify, and monitor account detail or workflow processes for barriers; make process improvements or initiate courses of action for problem resolution
• Participate in new hire interviews, facilitate associate orientation, and participate in the termination process (i.e. document performance issues, recommend disciplinary actions)
• Provide ongoing guidance to employees, via career coaching, counselling, and performance appraisal
• Independently lead initiatives as assigned by management, coordinating task teams or other forums to deliver results as identified and/or determined by leadership; provide formal updates and closure
• Handle escalated requests from clients and/or executive leadership
• Ensure strict confidentiality of all medical records, PHI, and PII
• Additional duties as assigned

KNOWLEDGE & SKILLS:

• Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
• Strong knowledge of Microsoft Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet
• Strong analytical and problem-solving skills
• Strong attention to detail and ability to deliver results in a fast-paced and dynamic environment
• Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results and innovation
• Ability to work independently and within a team environment

EDUCATION & EXPERIENCE:

• 5+ years of relevant experience in a medical or insurance field
• 3+ years of relevant experience or equivalent combination of educations and work experience
• Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable
• 3+ years of previous supervisory/management or project management experience a plus
• Associate degree or higher preferred

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $23.15 - $34.54 per hour

ABOUT CERIS:

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.