Supervisor, Provider Disputes

Residency in or relocation to Louisiana is preferred for all positions.

About the role

Oversees the daily operations of the unit for assigned staff in the unit. Serves as a leader and back-up for assigned staff in the unit. Coordinates workload and provides assistance on complex cases that require special expertise in the unit so that they are resolved in a timely manner. Complies with all laws and regulations associated with duties and responsibilities.

Nature and scope

Manages 12 direct reports in the Provider Disputes Specialist role. Reports to the Manager of Medical Coding. Regular contact with various internal and external entities including all levels of BCBSLA personnel, attorneys, group leaders, members, hospitals, physician offices, and the Department of Insurance.

Responsibilities

• Administers all HR functions, including hiring, terminating, conducting performance reviews, setting performance standards, approving work schedules, assigning and directing workload, training and developing staff, and coaching to ensure team goals are met.
• Serves as the subject matter expert to ensure accurate and timely handling of all cases. Maintains thorough knowledge of all contract types, changes to recent laws and regulations, computer systems, and claims policies and procedures to ensure consistency in processes and responses.
• Motivates, coaches, audits, and trains staff by answering questions, providing technical assistance, reviewing case files and letters to ensure deadlines are met and compliance with company policy, laws, and regulations are maintained.
• Identifies and reports weekly trends in production, inventory levels, and performance statistics.
• Interfaces with providers to promote education, consistency, and satisfaction.
• Coordinates the daily workflow to ensure compliance with established internal and external policies and procedures to ensure timeframes are satisfied.
• Assists in the development of departmental policies and procedures.
• Makes complex decisions involving consumer and provider contracts to ensure compliance with state and federal regulations, accreditation, and business practices.
• Familiar with the many differences in the Self Funded block of business and our fiduciary responsibility and requirements.
• Performs other job-related duties as assigned, within your scope of responsibilities.

Requirements

• High School Diploma or equivalent required; Bachelor's degree in a related field preferred.
• 5 years of insurance experience to include experience in disputes, appeals and grievances, adjustments, and customer service, plus one year of demonstrated leadership experience. Experience can run concurrently. 2 years of leadership experience preferred.

Skills

• Ability to read and interpret benefits for all lines of business.
• Ability to read and interpret all provider contracts and manuals.
• Knowledgeable and able to provide technical guidance on claims processing and complex appeals functions and cases.
• Demonstrated knowledge of accreditation guidelines, state laws, and relevant PC software (Facets, Epic, MS Word, Query Tools, Excel, Outlook) preferred.
• Attention to detail and excellent record-keeping skills.
• Ability to work in a rapidly paced and ever-changing environment.
• Able to make decisions, prioritize, find solutions, and work independently.
• Strong analytical, organizational, verbal, and written communication skills.
• Excellent time-management and interpersonal skills to respond to numerous inquiries in a diplomatic and timely manner.
• Presentation and public speaking skills.

Physical demands

• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• Ability to comprehend, document, calculate, visualize, and analyze is required.