Req ID: RQ200544
Type of Requisition: Regular
Clearance Level Must Be Able to Obtain: None
Public Trust/Other Required: None
Job Family: Healthcare Claims
Skills:
NCQA Standards,Provider Enrollment,Supervision
Experience:
5 + years of related experience
Job Description:
Healthcare Claims Supervisor
NCTracks was implemented by CSRA in July 2013 and used by the Division of Health Benefits (DHB); the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS); and the Division of Public Health (DPH). CSRA is the fiscal agent for NC DHHS and handles the daily operations and functionality enhancements to NCTracks.
Providers enrolled in DHB, DMH/DD/SAS and DPH health plans submit claims for payment of covered health care services through the NCTracks Provider Portal and to pre-paid health plans. NCTracks coordinates processing among the payers to ensure the proper assignment of the payer, benefit plan and pricing methodology for each service on a claim. NCTracks processes health care claims, prior approval requests, provider enrollment, finance, and other healthcare transactions.
We are looking for a Provider Enrollment Operations Supervisor to join our team.
Duties and Responsibilities:
Supervises, hires, trains, evaluates and disciplines employees.
Conducts performance evaluations and provides continuous feedback.
Plans, organizes and controls the daily operation of the Provider Enrollment Team.
Develops and implements policies and procedures to increase efficiency and productivity.
Assesses the work performance of the Provider Enrollment Team to identify areas that need improvement.
Assigns staff to the various enrollment operations and instructs them when necessary so they are trained to perform assigned duties in accordance with established business rules and desk procedures.
Provide team with communication impacting Provider Enrollment.
Provides exceptional customer service and maintains proper communication with the client and other departments.
Acknowledge and follow up with Team Leads and Enrollment Specialist on their questions and concerns.
Conduct Team Meetings, as needed, with minutes attached.
Plans and implements various events and team building activities to boost employee morale and engagement.
Advocate for employee needs and interests to grow within the organization.
Review and validate timesheets for accuracy. Approve timesheets and Leave Requests in a timely manner.
Review the Quality Control Analysts' internal quality audits, DHB audits, and other quality findings with the Enrollment Specialists monthly.
Provides feedback to Enrollment Specialists answering questions, explaining procedures and policies as required.
Serve as the backup for the other Enrollment Supervisor.
Collaborates with the Provider Enrollment Manager in the development of new and existing desk procedures to meet future needs.
Escalate team HR issues to Manager.
Providing information to Manager when requested.
Performs related duties as required.
Qualifications:
Bachelor's degree in Business, Finance, Health Care or related field preferred; or high school diploma and appropriate combination of education and experience.
Minimum of 5 years related experience required; 1 - 3 years of experience leading credentialing teams.
Working knowledge of Medicaid and NCQA credentialing certification regulations, policies and procedures.
Ability to communicate and collaborate with internal and external professionals, including stakeholders and providers.
Exceptional verbal and written communication aptitude, with proven ability to positively influence behavior. Conflict resolution and change management competency.
Ability to handle confidential and sensitive information.
Empathy and the ability to relate to employees at all levels.
Process and operational improvement experience required.
Ability to train/coach new hires and existing staff.
Highly self-directed, motivated and able to work independently with minimum level of supervision. Strong computer skills a necessity.
The likely salary range for this position is $72,509 - $97,750. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.
We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.
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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans
