Appeals Supervisor

Job Description

Job Description

The Provider Relations Supervisor will be responsible for daily operations within the Provider Relations department. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests along with appeal submissions.

Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we

deliver service to our customers.

This position is Hybrid.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES :

Ability to assist team with problem solving regarding customer complaints, or inquiries, including bill

review disputes verbally and in written communication.

Ability to review detailed provider appeals and provide both verbal and written communication that

includes industry regulations along with applicable client policies.

Maintain an awareness of current laws, statutes, regulations, etc. that impact healthcare

operations, and assist in design strategies for implementation activities within the organization.

• Responsible for ensuring new employees are oriented to the organization, its policies, facilities, etc.
• Supervisors should also provide ongoing guidance to employees, often in the forms of ongoing

career coaching, counseling and performance appraisal.

Develops and maintains strong collaborative relationships with internal departments and external

clients to maintain excellent lines of communication and share resources to meet business

objectives.

• Monitors employee performance and identifies any training issues for employees
• Builds customer relationships, interprets customer needs and assesses their business requirements.
• Assists with special projects as assigned by leaders such as interim or stretch roles for personal

growth opportunities, collaboration, and providing support to other departments as needed.

Standard supervisory duties such as : time approval, annual performance review

KNOWLEDGE & SKILLS :

• Proven strong leadership skills as a performer / leader
• Knowledge of Medicare (CMS) and Medicaid regulations, regulatory compliance, Managed Care, and

medical claims processing guidelines.

MS Word, Excel and Outlook experience, which extends beyond just their basic functionality. (i.e.

pivot tables, conditional formatting, advanced formulas)

EDUCATION & EXPERIENCE :

5+ years of relevant experience in a medical or insurance field, which required heavy involvement in

bill review processing of claims.

• 2+ years of previous supervisory / management or project management experience a plus.
• Bachelor’s degree or higher preferred

PAY RANGE :

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors : federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.

Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.

The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range : $21.16 - $34.04 per hour

A list of our benefit offerings can be found on our CorVel website : CorVel Careers Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners.

Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments.

We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities.

We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w / Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

LI-Hybrid