JOB SUMMARY:

Provide supervisory support to the Medical Claims Processing division of Correctional Managed Care (CMC)-Finance department, where the primary function is making timely, accurate payments to healthcare providers serving inmate populations covered under CMC’s managed healthcare contracts.  Reports to the Assistant Director-Financial Services, CMC-Finance.

ESSENTIAL JOB FUNCTIONS:

• Contribute to the success of the UTMB Correctional Managed Care program.
• Supervise medical claims processing activities within CMC-Finance.  “Working Supervisor” role that includes claims processing duties (re: job description for Claims Processing Specialist) in addition to determining work procedures, assigning/adjusting/monitoring staff workload, evaluating staff performance, and reporting the status of claims operations to CMC-Finance management.
• Ensure staff is educated & trained on CMC claims processing policies & procedures, which includes staying abreast of updates/changes to medical coding standards and Medicare payment rates.
• Perform pre-payment review of all claims processed for payment, which includes reviewing for data entry accuracy, proper medical coding of services billed, and the correct application of contract payment rates.
• Perform initial review of appealed claims, with recommendation for final payment determination.
• Review & approve updates to Vendor/Provider data tables.
• Assist with claim system updates to medical coding and contract payment rates data table.

MARGINAL OR PERIODIC JOB FUNCTIONS:

• Performs related duties as required.

REQUIRED EDUCATION / EXPERIENCE:

Associates degree or equivalent in business or related field, and 3 years related experience, 2 of which in a supervisory capacity. 

EQUIPMENT:

Standard office equipment.

WORKING ENVIRONMENT/LOCATION OF POSITION:

Standard hospital, clinical, laboratory and/or office environments.  May be exposed to such occupational hazards such as communicable diseases, harmful chemicals, and/or disoriented or combative patients. Describe travel requirements and other physical demands of job.

OTHER:

Specific job requirements or physical location of some positions allocated to this classification, may render this position security sensitive, and thereby subject to the provisions of Section 51.215, Texas Education Code.

ANY QUALIFICATIONS TO BE CONSIDERED AS EQUIVALENTS IN LIEU OF STATED MINIMUMS REQUIRE THE PRIOR APPROVAL OF THE CHIEF HUMAN RESOURCES OFFICER.