Claims Processing Supervisor supervises the administration of health insurance claims, payment processing, billing research, and responding to inquiries. Ensures the accurate and timely disposition of claims and resolves matters according to coverage amounts and company procedures. Being a Claims Processing Supervisor provides guidance to staff on more complex or high-value claims. Reviews and resolves escalated issues. Additionally, Claims Processing Supervisor requires a high school diploma. Typically reports to a manager. The Claims Processing Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. To be a Claims Processing Supervisor typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision. (Copyright 2024 Salary.com)
Supervises daily operations of the Sterile Processing department including planning, organizing, staffing and monitoring of work quality. Provide leadership and direction in the development and implementation of instrument sterilization policies and procedures in accordance with regulatory bodies. Effectively utilize available and developing technology to improve operations and control costs. Responsible for the sterilization processes, including decontamination, set up, sterile processing and storage of instruments and equipment. Actively assists with orientations, competency validations, and performance improvement initiatives.
Why UnityPoint Health?
Hear more from our team members about why UnityPoint Health is a great place to work at https://dayinthelife.unitypoint.org .
Leadership
• Supervises staff in the development and implementation of departmental policies, procedures, and programs.
• Collaborate with Manager to establish annual goals and objectives.
• Works closely with leadership to develop and maintain fiscal reporting, annual operating and capital budgets.
• Assists with overall staffing of the unit including onboarding, facilitation of orientation program and training of newly hired team members, and team member performance management.
• Responsible for effectively resolving complex situations and crises as they occur within the department in the absence of the SPD manager.
• Prioritizes, reassigns, and redistributes work, to include scheduling and delegating workflow of patient care in an organized manner.
• Coordinates orientation program and training of newly hired team members.
• Collaborates with Manager, effectively resolving complex unit situations, such as customer complaints and crises as they occur within the unit.
• Evaluates and guides staff through coaching and provides immediate feedback and responds to difficult inquiries and problems.
• Coordinates staff education/in-services/specialized skilled training programs including competencies.
• Assists with performance evaluations.
Clinical Excellence
• Responsible for performing and maintaining sterilization validations specific to each modality of sterilization and serves as the subject matter expert for the department. Ensure compliance by team member to follow regulatory and organizational policies, procedures, and safety standards.
• Collaborates with system partners to align best practice in the area of sterile processing.
• Ensures patient safety through follow-up of event reporting system.
• Makes recommendations and assists leadership in the procurement of surgical instruments and equipment.
• Adheres to regulations and guidelines set forth by regulatory agencies (Department of Health, Department of Transportation, Environmental Protection Agency,and others).
Performance Improvement
• Conducts employee rounding to meet standards.
• Collaborates with manager to develop and implement departmental performance improvement activities and assures ongoing staff participation.
• Reviews feedback from customers, responds, compiles, and analyzes support data and implements procedural changes as appropriate.
• Coordinates and prioritizes Operating Room requests for instruments and tray modifications.
Basic UPH Performance Criteria
• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
• Demonstrates ability to meet business needs of department with regular, reliable attendance.
• Employee maintains current licenses and/or certifications required for the position.
• Practices and reflects knowledge of HIPAA, JCAHO, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
• Completes all annual education and competency requirements within the calendar year.
• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Minimum Requirements
Education: High school graduate or equivalent.
Experience: Two or more years of experience in sterile processing.
License(s)/Certification(s):
CRCST (Certified Registered Central Service Technician)
CIS (Certified Instrument Specialist)
CER (Certified Endoscope Reprocessor) preferred
CHL (Certified Hospital Leader) preferred
Knowledge/Skills/Abilities:
Advanced knowledge of field, in-depth knowledge of the “why’s.”
Ability to maintain current professional expertise.
Exhibits discretion and sound judgment in all aspects of the job.
Promotes positive interpersonal relations and serves as a role model within the department and with hospital personnel.
Writes, reads, comprehends, and speaks fluent English.
Multicultural sensitivity.
Microsoft Office – basic computer skills.
Customer/patient focused.
Critical thinking skills using independent judgment in making decisions.
Demonstrates the ability to interpret, apply and follow personnel policies/procedures fairly and consistently.
Other:
Use of usual and customary equipment used to perform essential functions of the position.
Work may occasionally require travel to other UPH facilities. .
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