The Centralized Edit Team Supervisor oversees supervises the daily activities of the Centralized Edit Team and oversees the daily workflow to ensure Conifer Health Solutions maintains the highest quality for accurate and compliant claims submission and reimbursement with a focus on denials and account/claim edits reduction. Supervises and provides direct oversight of individual CET team members including developing, communicating, and monitoring daily work assignments, approving time off based on business needs, reviewing and/or approving payroll, quality assurance/review activities, and various coaching, education, and training activities. Ensures that policies, procedures, and other work tools are accurate, current, consistent, and readily available to team members. Serves as a subject matter resource and in a consultative role to various levels of customers working closely and collaboratively with other internal and external customers. Responsible for fostering and maintaining strong, collaborative relationships with all levels of staff both internally as well with the facilities, partners, and/or clients we serve including clinical teams and hospital departments.
Responsibilities and Duties
- Supervises Claim Edit Analysts and assesses daily operations of the team to establish teamwork schedules, streamline workflow, provide ongoing communication, and daily monitoring to ensure team performance is in alignment with CRI's and Conifer's strategic plans and key performance indicators. Monitoring, evaluating, mentoring, and coaching employee performance using performance management system and personal computing applications. Providing input into performance goals to the CET manager, Director and/or senior management, set goals for employees and team in collaboration with management for each review period. Identifying staff needs and removing barriers to ensure staff can meet the quality, productivity, and performance expectations set for them including identifying training needs, developing training programs, and implementing them. [30%]
- Researching, interpreting, monitoring, assessing, and tracking of revenue cycle, regulatory, 3rd party payer, and/or reimbursement risks and/or changes in collaboration with the CET manager to ensure the team's essential functions are responsive to those, compliantly. [15%
- Identifying and root causing revenue cycle edits and/or denials that negatively impact operations, assisting and collaborating in the development of enterprise-wide solutions to prevent/minimize, working with various levels of management to obtain approval for process changes, and partnering to implement them within the organization while maintaining successful project outcomes with minimal to low impact on current operations. [10%]
- Providing regular reports to RCRS Manager regarding the status of the team and/or initiatives, any corrective action being taken, and/or any recommended changes/updates. [10%]
- Assessing business unit needs in collaboration with the Manager to ensure adequate staffing; collaborating with the Manager and the human resources and recruiting departments to identify and interview including making hiring recommendations to the Manager. Providing coverage, as needed, for fluctuations in volumes to assist team members with meeting key performance indicators. [10%]
- Serving as a subject matter resource and in a consultative role to various levels of customers, works closely and collaboratively with other internal departments. Establishing, fostering, and maintaining strong, collaborative relationships with all levels of staff both internally as well with the facilities, partners, and/or clients we serve including clinical teams and hospital departments. Communicating department and company information/updates to stakeholders and employees via one-to-one and/or team meetings timely and on a regular basis. Meets routinely (weekly/bi-weekly, etc.) with other team supervisors to share findings and identify overlapping/enterprise-wide issues. [10%]
- Assist in the development of compliant policies, procedures, and/or job aids, review and provide recommended updates to Manager annually or as appropriate based on updated rules and regulations. Ensures that policies, procedures, and other work tools are accurate, current, consistent, and readily available to team members. [5%]
- Ensuring all team members are knowledgeable about changes in revenue cycle practices, rules, and/or regulations through regular audits, reviews, and aggregate data analysis including organizing training and professional development opportunities for all team members.
- Provides input regarding department budget specific to area of responsibility and monitors expenditures for budget compliance. [5%]
Other duties as assigned [5%]
