HealthPartners · 6 hours ago
Payment Integrity/SIU Technical Coordinator
Bloomington, MN
Full-time
Onsite
Mid, Senior Level
2+ years expHealthPartners is a nonprofit, integrated health care organization providing health insurance and high-quality care across multiple states. They are seeking a Payment Integrity/SIU Technical Coordinator to provide technical supervision, oversee claims adjudication, and develop staff competencies to ensure efficient claims processing.
MedicalPharmaceutical
Responsibilities
Assists in the selection, development and supervision of staff to ensure achievement of department objectives
Selects and motivates a competent workforce
Assumes the role of supervisor in the absence of the supervisor, this includes but is not limited to signing timecards, hiring and firing decisions, union issues and time off approval
Develop staff technical competence to ensure maximum production and quality standards
Designs and revises procedures as necessary to facilitate and make claims processing as efficient as possible
Prepares, conducts and analyzes both system and user audits to ensure new, promoting and existing employee’s technical competence, to heighten production and quality standards, improve and maximize system use
Provide follow up support through evaluation session with each staff member
Supports staff in identifying potential improvements in automated or manual processes
Provides expertise in training of system functionality including all modules of the claims system and DEC applications (auths, supplemental insurance, claims processing, on line benefits, membership systems, HCSS, etc.)
Investigates claims problems and assists in their resolution
Conducts training of new examiners and remedial training of experienced examiners as needed
Performs benefit interpretation to define and facilitate development of procedures resulting from implementation or revision of claims processes
Maintains a current knowledge base and utilizes new training techniques and documentation
Ensures efficiency, eliminates redundancy, and utilizes other administrative resources for claims processing needs
Ensures the quality to data collection through an audit process to meet the expected standards of the system users
Facilitates management assimilation of data by interpreting reports and highlighting trends
Determines quantity of claims required for the auditing of each examiner
Audits and authorizes payment of claims over examiner’s limits
Supports unit, departmental and divisional teams through participation and appropriate meetings and projects
Support includes coordination of all processes affected by the project to capture complete information for appropriate training documentation and implementation
Interacts with other supervisors and their personnel from other departments or organizations to resolve mutual problems
Participates in departmental planning and redesign
Performs additional duties, attends meetings and assumes projects as assigned by supervisor, manager or director
Qualification
Required
Bachelor's degree with at least two years of claims experience in the administration of insurance benefits, or Associate degree with two years of HealthPartners experience. Education requirement may be waived based on a minimum of four years of claims processing experience with demonstrated technical expertise
Advanced analytical and problem solving ability
Working knowledge of HealthPartners mainframe systems or equivalent experience with other claims systems
Effective presentation, planning, oral and written communication skills with the ability to communicate at all levels of the organization and with external customer
Detailed knowledge and understanding of the insurance industry including claims processing and customer service expectations
Able to interpret and explain provider and member/employer contracts
Must be highly flexible, able to handle and manage a high degree of change
Able to work independently and as a team player
Knowledgeable of total quality management concepts
Able to identify individual training needs and provide appropriate instruction
Preferred
Bachelor's degree in management, business administration, or an Associate degree with at least two years of HealthPartners claims processing experience
Working knowledge of HealthPartners claims processing systems
Thorough knowledge of HealthPartners member and provider contracts
Working knowledge of reporting programs
Previous project management experience
Experience using desktop publishing software e.g., Microsoft Word, Excel, PowerPoint and familiarity with training equipment and materials
Benefits
Health
Time off
Retirement planning
Continuous learning opportunities
Company
HealthPartners
HealthPartners, an integrated health care organization providing health care services and health plan financing and administration, was founded in 1957 as a cooperative.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$116M2020-05-07Debt Financing· $110M
2016-05-02Grant· $6M
Leadership Team
Penny Cermak
Executive Vice President and Chief Financial Officer
William Frey II
Research Director, Center for Memory & Aging, Neurosciences
Recent News
Canadian News Wire
2023-01-23
2022-12-07
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