Supervisor, Coding & Claims Resolution Analysts

Job Category: Operations

Requisition Number: SUPER
006230

• Full-Time

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Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Supervisor of the Coding Analysts and Claim Resolution Analysts within Operations is responsible for the Coding and Claim Teams, and providing oversight and management of issue resolution for Medica’s members and providers across all business/products. The Coding Analysts and Claim Resolution Analysts support the timely resolution of issues received from Medica’s Customer Service (members/providers – all products) and issues received directly from Medica’s key providers and leased provider networks.

The supervisor is responsible for managing the team’s performance and meeting our customers’ expectations for turn-around-time. The supervisor works toward root cause analysis by partnering with internal and external (vendor) partners. The supervisor supports internal customers and works with both internal and externa l vendor partners. Performs other duties as assigned.

• Leverages knowledge of all Medica products, policies and processes. Accurately interprets member and provider contracts and follows Medica’s procedures
• Identifies processing errors or claim payment trends, accurately identifies the source and root cause of problems
• Identifies inappropriate coding trends, claim processing trends, and system set up issues that result in errors and engages the appropriate players as necessary to develop a plan to resolve the trends
• Identifies trends by analyzing complex operational issues and reviewing provider contracts, files, systems, policies and procedures to formulate clear picture of the situation, identifying cause and effects
• Proactively communicates to providers, members, and internal customers within an appropriate time frame. Documents all provider and other applicable issues in ePIL database following the established business rules. Utilizes all software applications needed to adequately research and resolve claim issues (i.e. IDRS, ISET, Info Reports, COSMOS, Health Rules, etc.)

• Supervises staff, sets objectives, coaches and develops, provides feedback and conducts annual performance reviews
• Holds regular staff meetings/huddles and 1:1 meetings
• Manages staffing, training, scheduling, and team morale
• Promotes a positive working climate that supports open and honest communication, integrity, service quality, and innovation and is achievement-focused
• Manages performance and holds staff accountable for meeting department standards. Formulates action plans for less than acceptable performance

• Contacts and coordinates resources (other departments, vendor partners, providers) to resolve identified operational issues in an effective and timely manner
• Coordinates data from provider, Siebel/Oracle reports, and customized reports to identify accurate data for claims projects
• Monitors claims project status progress and communicates progress to various stakeholders (providers, network management, upper management, customer service operations, etc.) Documents project status and…