Aetna Supervisor, Clinical Health Services in Tampa, Florida
Req ID: 48474BR
Please note: This is a full time work at home position. Candidates must be local to the Tampa, FL area and must be able to come into the office when needed.
The Supervisor is responsible for oversight of Workers Compensation Nurses and Certified Coders in Bill Review, which includes maintaining a high performing production team. The Supervisor will work closely with the Manager to insure Quality and Production metrics are met.
Responsible for the daily supervision of medical review team of nurses and certified coders who provide claims review for workers compensation in a Bill review platform.
Provides day-to-day oversight and direction to a medical review team including staffing and performance evaluation.
Provides oversight for medical reviews for coding and billing accuracy
Processes complex claims and adjustments according to company policies and procedures.
Researches customer information in response to difficult inquires including, but not limited to, authorization, payments, denials and coordination of benefits.
Assesses, investigates and resolves difficult issues to achieve customer satisfaction.
Actively participates in the development, implementation, and oversight of the departments activities.
Assists in the identification of issues which may adversely impact the attainment of department goals and initiatives.
Identifies training needs within the team. My train service teams based on outcomes of medical reviews,as well as process and/or procedure changes.
Drives the team to identify and implement process improvements; encourages ownership of and group participation in improvement initiatives within the team.
Must be able to identify and recommend opportunities for cost savings and outcome improvement
3+ years of supervisory experience for direct reports between ranging from 10-15.
Ability to maintain production levels and quality goals is required
Strong analytical and problem solving skills are required
Excellent organizational, interpersonal and communication skills are required
Must have a working knowledge of Microsoft Office Suite (Word, Excel, PowerPoint and Outlook)
Experience with customer/client concerns that are escalated to bring them to quick resolution is preferred
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Medical management is desired
Claims experience is desired
Leadership experience is desired
Functional - Nursing/Clinical claim review and coding/5+Years
Functional - Leadership/Lead a complex or multifunctional organization/3+ Years
Functional - Clinical / Medical/Clinical claim review & coding/1+ Years
Functional - Quality Management/Quality Management/3+ Years
Functional - Claims/Management: < 25 employees/3+ Years
Technical - Aetna Applications//1+ Years/End User
Technical - Performance Tuning/Capacity Planning//4+ Years/End User
Technical - QA Tools//4+ Years/End User
Technical - Desktop Tools/Microsoft Outlook/4+ Years/End User
ADDITIONAL JOB INFORMATION
Opportunity to grow in leadership to upper management positions within the work product. Develop rapport with Business Process Outsourcing with our vendor management overseas.
Experience in Workers Compensation Claims. Bill Review background experience preferred.
Supervisor experience over medical professionals. Looking for experience with provider outreach calls to resolve escalated topics regarding their bill charges.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Function: Health Care