We partner with over 1,000 healthcare providers to maximize their complex claims reimbursements.
Supervisor, Out of State Medicaid
Location
United States
Posted
76 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Supervisor, Out of State Medicaid
EnableComp
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years. Position Summary The Supervisor, OSM is a critical support role that oversees a team of Revenue Specialists and Account Managers and serves as the internal escalation point for claim processing resolution. This role also supports the overall success of our client’s accounts by managing and responding to client inquiries, engaging document management processes for the purpose of processing claims as well as payment research, invoice/billing inquiries, file delays, system access, and other relevant items. Key Responsibilities - Responsible for the daily supervision of assigned Revenue Services teams. - Serves as the primary escalation point, to directly or through staff, work with clients to resolve roadblocks that may hinder the claims resolution process and provides direction to Account Managers and Revenue Specialists to resolve existing claims/ client issues. - Partners with Managers to disseminate priority of daily tasks to assigned team. - Prepares performances evaluations and account reviews and plays a role in delivering both documents in conjunction with the Department Leader. - Analyze and evaluate claim payments using EnableComp’s proprietary software, systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state worker’s compensation fee schedule and/or PPO contract. - Research, request and acquire all pertinent medical records, implant manufacturer’s invoices and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement. - Manage internal coordination, communication, and messaging for external client requests and reported issues. - Create, review, and maintain external-facing client reports. - Facilitate internal and external meetings to discuss process improvements, resolve client issues, and/or resolve internal issues. - Respond and communicate with external clients regarding topics such as: remote system access, document requests, payment research requests, coordination of end-user training, and others. - Conduct timely and thorough telephone follow-up with insurance companies to ensure proper reimbursement. - Prepare correct initial bill packet or appeal letter using EnableComp systems tools. - Works with Data Analytics team to research issues with claim and payment imports, etc. - Trains and mentors staff as needed including new hires, especially in regards to ongoing training needs that may result from the SOP for goal escalation. - Works with Data Quality team to research issues with calculations and other projects. - Works with Document Management team to remove roadblocks around document acquisition and other requisite items needed to collect accounts. - Perform Quality Control tasks on behalf of management regarding account flow and due diligence. - Usually works more difficult clients. - Responsible for the full employee life cycle including hiring decisions, training, performance management, and corrective action. - Handle patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information. - Support operational initiatives through team collaboration. - Other duties as required. Requirements and Qualifications - High School Diploma or GED required. Associates or Bachelor’s Degree a plus. - 5 years’ experience in healthcare field working in billing or collections. - 5 years’ client facing/customer services experience. - 1-2 years supervisory or team lead experience. - 3-5 years’ experience with workers compensation billing and collections preferred. - Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements. - Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook). - Equivalent combination of education and experience will be considered. - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. - Regular and predictable attendance. Special Considerations and Prerequisites - Must demonstrate exceptional interpersonal skills and exhibit an approachable nature to answer questions from Revenue Specialist staff and mentor and train others regularly. - Can-do attitude with service-oriented approach and strong sense of urgency with skills to develop and coach team members. - Must be a self-starter and able to work independently without direct supervision. - Proven written and verbal communication skills. - Strong analytical and problem-solving skills. - Appropriately handle stress and interact cooperatively with others (at all levels of the organization). - Proven experience working with external clients; strong customer service skills and business acumen. - Ability to prioritize and manage multiple competing priorities and projects concurrently. - General office environment; must be able to sit for long periods of time. EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you. Don’t just take our word for it! Hear what our people are saying: “I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” – Revenue Specialist “I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” – Supervisor, Operations
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