ACM BUSINESS SOLUTIONS, LLC · 19 hours ago
Supervisor, EDI Claims
United States
Full-time
Remote
Mid, Senior Level
$120K/yr - $140K/yr
4+ years exp
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Hiring Manager
Richard Dotson
Insider Connection @ACM BUSINESS SOLUTIONS, LLC
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Responsibilities
Manage and provide direction to ensure all electronics claims files are processed timely.
Ensure all files are received according to expected timelines and escalate issues when needed.
Provide support to resolve processing or data issues and escalate issues when needed.
Support the programming of required logic and implementation of tools, systems, and applications used for the loading of claims into EZ-CAP.
Develop and maintain productivity and reconciliation reports, including but not limited to inbound electronic claims volume and data accuracy reports.
Facilitate the development, review, and revision of team policies, procedures, and workflow diagrams.
Collaborate effectively with internal and external stakeholders to ensure the smooth execution of team functions, including but not limited to the Claims Operations department.
Collaborate with HIT leadership to develop benchmark measures that evaluate work productivity and quality.
Review and analyze the effectiveness and efficiency of existing processes and develop strategies for improvement.
Ensure that complex claims EDI issues are resolved within established guidelines.
Serve as technical and informational resource for all TMs, facilitating TM training and mentorship.
Evaluate work assignments in support of efficient file processing.
Respond to escalated questions and/or issues brought up by the team.
Monitor and manage TM time, overtime, and scheduling.
Develop new EDI solutions for business operations as needed to remain compliant with regulatory requirements.
Other job responsibilities as assigned.
Qualification
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Required
Strong knowledge of HIPAA ANSI 834, 270, and 271 format(s) and Health Plan proprietary formats.
Bachelor’s degree or 4+ years equivalent work experience in a similar role
Ability to navigate EZ-CAP, Tableau, and Smartsheet
Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote)
Strong organizational skills, with the ability to manage several projects and priorities at the same time.
Ability to work effectively with all levels of the organizations and stakeholders, including health plans and clients.
Positive attitude and flexible, a must.
The ability to take initiative while remaining open to the ideas of others.
Strong communication, analytical, coaching/mentoring, and team building skills.
Ability to troubleshoot problems and recommend, develop, and implement effective improvements.
Ability to use sound judgment in completing tasks and to seek guidance when needed.
Company
ACM BUSINESS SOLUTIONS, LLC
LONGWOOD, Florida, US
2-10 employeesFunding
Current Stage
Early StageCompany data provided by crunchbase
