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PRIA Healthcare Management LLC

Billing/Reimbursement Supervisor

Senior Management – Torrington, Connecticut
Department Senior Management
Employment Type Full-Time
Minimum Experience Manager/Supervisor

Program Lead (Case Management)

 

This is an exciting opportunity to join a rapidly growing company!

 

PRIA Healthcare Management is a patient access and reimbursement solutions company specializing in patient based appeals of denied care. We are currently looking for a Program Lead that is ready to join our team of skilled and dedicated individuals supporting the mission of patient access to care and customer service.

 

Experience working with insurance appeals and the prior authorization process and knowledge of medical reimbursement policies within a healthcare organization is required.

 

Job Responsibilities:

 

  • Possess strong organizational, administrative, leadership and interpersonal skills; must be able to work independently and in a team environment with a wide variety of people
  • Oversee Case Manager(s) for identified program, provide leadership to the team
  • Provide training, guidance and direction to Case Managers as needed
  • Work in conjunction with Client Engagement Manager to be main point of contact for clients; weekly program reviews, calls, frequent questions or concerns regarding the program
  • Run reports and manage case distribution amongst team
  • Review caseloads on a daily/weekly/monthly basis and perform case audits on an as-need basis
  • Report data and audit results into findings report and share with management
  • Understands, supports, and improves all Standard Operating Procedures for assigned program
  • Participates in Program Lead meetings; create supervisory, management reports for meeting as needed
  • Works closely with other Program Leads to improve operations practices
  • Case management and processing utilizing Salesforce.com platform
  • Provide oversight at all levels of an insurance appeal
  • Utilize appropriate resources to gather supporting documentation (i.e. state protocols, physician/hospital medical records, state or federal statutes, patient/physician letters, etc.)
  • Provides exceptional service to clients, patients and providers
  • Interact closely with payer appeals and utilization departments
  • Researches payer statutes, regulations, and regional requirements
  • Comply with company HIPAA laws and other policies and procedures

 

Required Skills:

 

<!-- [if !supportLists]-->·       <!--[endif]-->Experience managing multiple people (Case Managers)

<!-- [if !supportLists]-->·       <!--[endif]-->Hiring, interviewing and training skills are a must

<!-- [if !supportLists]-->·       <!--[endif]-->Ability to create a positive and fun team environment

<!-- [if !supportLists]-->·       <!--[endif]-->Must be proficient in Microsoft Office

<!-- [if !supportLists]-->·       <!--[endif]-->Must demonstrate excellent communication skills, verbal and written

  • Experience working with insurance claims, appeals, prior authorization and utilization review is preferred but not a must
  • College degree preferred but will substitute for applicable work experience
  • Experience with Medicare, Medicaid, Tricare, Workers Compensation and Commercial Insurance
  • Must demonstrate the ability to draft professional and effective appeal letters
  • Expertise in CRM software is a plus
  • Must have solid knowledge of patient account systems and ability to troubleshoot and suggest improvements
  • Knowledge of general office procedures and use of office equipment

 

Benefits:

PRIA Healthcare Management offers a competitive package of benefits including but not limited to Medical/Dental Insurance, 401K, Access to Long Term and Short-Term Disability, Paid Time Off and Paid Holidays.

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  • Location
    Torrington, Connecticut
  • Department
    Senior Management
  • Employment Type
    Full-Time
  • Minimum Experience
    Manager/Supervisor
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