MAXIMUS

  • Supervisor: Provider Services Claims Support

    Job Locations US-MA-Boston
    Posted Date 3 months ago(10/17/2019 11:25 AM)
    Requisition ID
    2019-45577
    # of Openings
    1
    Job Schedule
    Regular Full-Time
  •  

    Since 1975, MAXIMUS has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. MAXIMUS delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, MAXIMUS is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

    Job Description Summary

    MAJOR PURPOSE

    The Supervisor of Provider Services and Claims Support oversees and manages the daily activities for a team of Provider Research Specialists and monitors workflow, maintains quality standards and ensures work integrity within the department. The Supervisor will also coordinate with other functional areas to take the lead on any provider claims realted issues requiring resolution and reporting through the CARTS system. The supervisor may be required to interface with key personnel at EOHSS.

    JOB SUMMARY

    • Assign day to day tasks and activities related to provider research and claims support
    • Monitor employee performance for compliance to established protocols. Supervisor will review production reports and work queue items and compare them to established performance expectations
    • Work closely with and collaborate with Provider Relations staff, PEC staff and EDI staff to ensure all formal provider claims issues are resolved in a timely manner according to client expectations
    • Effectively lead, coach, train and counsel team members
    • Apply feedback to staff members to improve performance
    • Attend and participate in CARTS problem resolution team and represent claims realted matters
    • Develop policies and procedures which cross functional areas to support smooth and efficient processes to achieve goals and objectives
    • Educate Provider Operations managers, director and staff on financial/ claims updates and system changes to ensure synchronized process of problem resolution.

    EDUCATION REQUIRED

    • Bachelor’s Degree from an accredited college or university, or the equivalent combination of education and experience, required

    REQUIRED KSAS

    • General knowledge of Provider Enrollment and Credentialing regulations and requirements.
    • At least 2 years of claims related work
    • At least 2 years’ previous supervisory experience.
    • Excellent organizational, written, and verbal communication skills
    • Ability to perform comfortably in a fast-paced, deadline-oriented work environment
    • Ability to work as a team member, as well as independently

    PREFERRED KSAS

    • Previous experience working with MassHealth providers.
    • Knowledge of the MassHealth program
    • Experience in a health care environment
    • Knowledge of EOHHS regulations and program highlights.
    • Understanding of provider billing practices and claim processing

     

    Essential Duties and Responsibilities:
    - Responsible for assigning day to day revalidation work items.
    - Monitor employee performance for compliance to established protocol (SLA).
    - Work closely with Quality Assurance (QA) and Documentation Management areas to ensure all providers are revalidated timely and accurately.
    - Facilitate the monthly revalidation launch process and monitor all mailings related to the revalidation monthly cycle.
    - Effectively lead coaches and train and counsel revalidation specialist.
    - Research and respond to any escalated provider inquiries and requests in a timely, professional and informative manner.
    - Produce weekly/monthly revalidation reports to be presented to staff.

    Minimum Requirements:
    - Associate degree or equivalent combination of education, technical training or work experience considered in lieu of degree.
    - Minimum of two (2) years of related experience.
    - Ensure compliance with company Wage & Hour policy, including ensuring non-exempt employees get the rest & meal breaks.
    - Comply with all company required policies, procedures and processes including but not limited to required training.
    - Provides immediate supervision to a unit or group of employees, assigning tasks, checking work at frequent intervals, and maintaining schedules.
    - A portion of time is normally spent performing individual tasks related to the unit or sub-unit.
    - Generally supervises semi-skilled employees or a few individual professional contributors.
    - Works on issues of limited scope.
    - Follows established practices and procedures in analyzing situations or data from which answers can be readily obtained.
    - Monitors daily operations of a unit or sub-unit.
    - Requires full knowledge of own area of functional responsibility.
    - Frequently interacts with subordinate employees and functional peer groups.
    - Interaction normally requires the ability to gain cooperation of others, conducting presentations concerning specific projects or schedules.
    - Receives predetermined work assignments that are subject to a moderate level of control and review.
    - Directs subordinates to complete assignments using established guidelines, procedures and policies.

    - Develop work schedules and assign duties to subordinates to ensure efficiency.
    - Evaluate subordinates' job performance and recommend appropriate personnel action.
    - Discuss job performance concerns with subordinates to identify causes and issues and works closely with the Human Capital department on resolving problems.
    - Identify training needs and development opportunities for subordinates.

     

    EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

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