Aetna Supervisor Clinical Health Services in Tampa, Florida
Req ID: 42573BR
The Supervisor is responsible for the daily supervision of medical review team of nurses and certified coders who provide claims review for workers compensation in a bill review platform. This is a great opportunity to grow in leadership to upper management positions within the work product. Develop rapport with Business Process Outsourcing with our vendor management overseas.
Provides day-to-day oversight and direction to a medical review team including staffing and performance evaluation. Provides oversight for medical reviews for coding and billing accuracy Processes complex claims and adjustments according to company policies and procedures. Researches customer information in response to difficult inquires including, but not limited to, authorization, payments, denials and coordination of benefits. Assesses, investigates and resolves difficult issues to achieve customer satisfaction. Actively participates in the development, implementation, and oversight of the departments activities. Assists in the identification of issues which may adversely impact the attainment of department goals and initiatives. Identifies training needs within the team. My train service teams based on outcomes of medical reviews, as well as process and/or procedure changes. Drives the team to identify and implement process improvements; encourages ownership of and group participation in improvement initiatives within the team. Identifies and recommends opportunities for cost savings and improving outcomes.
Supervisory or some leadership background. Ability to maintain production levels and quality goals. Strong analytical and problem solving skills. Excellent organizational, interpersonal and communication skills. Experience with customer/client concerns that are escalated to bring them to quick resolution Understanding of Worker's Compensation Claims. MS Office: Power Point, Excel, Word and Outlook
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Claims/ is required
Medical Management/ is required
Leadership/ is required
Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years
Functional - Nursing/Medical-Surgical Care/4-6 Years
Functional - Leadership/Lead a business turnaround/1-3 Years
Functional - Medical Management/Medical Management - Clinical claim review/1-3 Years
Functional - Quality Assurance//1-3 Years
Technical - Aetna Applications//1-3 Years/End User
Technical - Remote Access//1-3 Years/End User
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Function: Health Care