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Corporate Functions & Operations WellCare - Claims Careers

Claims Audit - Supervisor Job

Full Job Title: Supv, Claims Audit

Job Number: 1804789

Location: Tampa, FL

Date Posted: 2018-08-16

Location: Idlewild Ave, Tampa, FL

Reporting to: Dir, Claims Audit

Department: Ops-Provider Operations

Position is responsible for overseeing, giving direction/feedback to their Audit team members with regard to completion and performance of their daily tasks and responsibilities. Acts as a subject matter expert for all audit questions/issues.

Essential Functions:

  • Acts as a Subject Matter Expert (SME).
  • Reviews all second level rebuttals.
  • Reviews Peer Review scores with Auditors and recommends process improvement.
  • Works with Manager to maintain appropriate work balance in the department in order to maximize productivity.
  • Assists in developing of long-range goals for claims audit specialist and Sr. claims audit specialists.
  • Accept the responsibilities of the manager of Claims Audit in his/her absence and ensure that the department runs smoothly & without disruption to the daily routine.
  • Researches and recommends solutions for escalated issues. Presents proposed solutions in a clear and concise manner.
  • Responsible for performance management responsibilities for direct reports.
  • Assists with developing and maintaining departmental policies and procedures including desk top procedures.
  • Assists with developing training materials for the department and facilitate training as needed.
  • Analyzes errors and performs root cause analysis in order to determine appropriate classification.
  • Presnts audit findings and / or mediates issues external to the department.
  • Assists with identification and communication of process improvement opportunities across operation areas based on quality reviews.
  • Performs additional duties as assigned.

Additional Responsibilities:

    Candidate Education:

    • Required A High School or GED
    • Preferred A Bachelor's Degree in a related field

    Candidate Experience:

    • Required 5 years of experience in a healthcare organization
    • Required 5 years of experience in understanding and interpreting contracts as related to claims processing and system configuration

    Candidate Skills:

    • Advanced Knowledge of healthcare delivery
    • Intermediate Demonstrated organizational skills
    • Intermediate Demonstrated time management and priority setting skills
    • Intermediate Ability to drive multiple projects
    • Intermediate Ability to work independently
    • Advanced Demonstrated analytical skills
    • Advanced Demonstrated problem solving skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
    • Intermediate Ability to work as part of a team
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Intermediate Ability to multi-task
    • Intermediate Other Decision making ability that requires the use of considerable judgment in the analysis of processes and problems/errors resulting from those processes
    • Intermediate Other Knowledge of HCPCS Coding
    • Advanced Other Ability to facilitate small group meetings
    • Advanced Other Ability to remain calm under pressure
    • Intermediate Other Ability to concentrate for extended periods on specific tasks

    Licenses and Certifications:
    A license in one of the following is required:

    • Preferred Other Certified Medical Coder

    Technical Skills:

    • Required Intermediate Microsoft Excel
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Other Demonstrated technical expertise in performing quality reviews along with analysis of results
    • Preferred Intermediate Other Knowledge of Perot / Peradigm system


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      Last Updated On: 12/9/2015