Philips Reimbursement Supervisor in Saint Paul, Minnesota

Position Title: Insurance Supervisor

Department: Insurance Verification & Authorization

Grade Level: 50

Position Status: Exempt

Reports To: Insurance Authorization and Verification Manager

Direct Reports: Insurance Specialists, Verification Specialists, Authorization Coordinators, Appeals Specialists

E-PHI Access: Full Access

Position Summary:

The Insurance Supervisor is responsible for the day-to-day operations of the Verification, Authorization, and Appeals team. This responsibility includes, providing direction and assistance to the specialists and coordinators to ensure tasks are performed accurately, efficiently, and timely to meet department and company goals. Under the guidance of the Insurance Verification & Authorization Manager and in partnership with the Insurance Training team, the Insurance Verification & Authorization Supervisor is responsible for developing, documenting, and updating departmental policies, procedures, and metrics. Additionally, the Insurance Verification and Authorization Supervisor will be responsible for interviewing/hiring, evaluating performance, coaching, disciplinary action and daily supervision of the specialists and coordinators to ensure that all department and company policies and procedures are followed.

Duties and Responsibilities:

Supervisory Duties and Responsibilities: 60%

  • Develop, monitor and manage all direct reports

  • Assist in and make recommendations on selection, promotions, merit increases and employee discipline

  • Conduct periodic and annual performance reviews for all direct reports

  • Identify team and individual training/improvement needs and assist in developing plans for immediate and long-term performance improvements

  • Review quality assurance monitoring for all team members on a frequent and ongoing basis to ensure adherence to all department and company policies and procedures

  • Ensure Insurance related tasks are performed accurately, efficiently, and timely by the Insurance Verification & Authorization Team to meet department and company goals

  • Ensure cross training within the department to ensure smooth work flow, functional coverage and staff development

  • Report recurring payer and/or appeal issues to the Insurance Verification & Authorization Manager

  • Ensure effective collaboration with external and internal team members and customers to create a remarkable experience for our customers, maximize reimbursement and business opportunities

  • Foster a positive and rewarding work environment for all team members

  • Facilitate team meetings on a weekly/bi-weekly basis

Policies, Procedures and Metric Duties and Responsibilities: 30%

  • Collaborates with Insurance Verification & Authorization Manager to create individual and team goals

  • Under the guidance of the Insurance Verification & Authorization Manager, develop, document, and update departmental policies and procedures

  • Evaluate department metrics to determine areas of success and areas needing improvement

Other Duties and Responsibilities: 10%

  • Develop and maintain working knowledge of current durable medical equipment (DME) products offered by the company and all applicable insurance guidelines as it relates to eligibility for coverage and reimbursement

  • Act as the Insurance Team liaison to internal and external customers to resolve problems for a timely and effective resolution

  • Support the insurance team by performing duties, when needed. Duties may include but not limited to : handling incoming calls, calling payers for in-depth insurance verifications, working on prior-authorization and letter of agreement requests, calling payers to following up on submitted prior authorization, reviewing and writing appeals, following up with patients or Territory Managers.

  • Facilitate and Participate in department meetings

  • Attend HIPAA and other training sessions as required

  • Understand and comply with all applicable company policies and procedures

  • Comply with all applicable local/state/federal regulations related to the medical device and durable medical equipment industries

  • Perform other related duties as directed by manager

Required Qualifications:

  • 2 or 4 year college degree in business or healthcare related field or equivalent work experience

  • Minimum 2 - 4 years supervisory/management experience

  • Minimum 2 years experience for candidates with a college degree or minimum 4 years experience for candidates without a college degree

  • Experience working for or with medical insurance companies in a healthcare setting, preferably in verifying insurance eligibility and benefit limits and/or submitting and receiving prior authorizations for service

Additional Qualifications:

  • Durable Medical Equipment (DME) experience preferred

  • Demonstrated superior customer service skills

  • Excellent communication skills, both verbal and written

  • Strong analytical and problem solving skills

  • Ability to organize and prioritize workload

  • Ability to work independently and as part of a team

Physical Requirements of the Position:

Candidate must be able to sit at a desk in front of a personal computer (PC) monitor for long periods of time. Position requires incumbent to use a PC, telephone, and basic office equipment. This position requires the candidate have the ability to conduct telephone conversations, read medical and insurance information and communicate clearly with all internal and external customers.

In this role, you have the opportunity to

Be responsible for the day-to-day operations of the Verification, Authorization, and Appeals team. This responsibility includes, providing direction and assistance to the specialists and coordinators to ensure tasks are performed accurately, efficiently, and timely to meet department and company goals. Under the guidance of the Insurance Verification & Authorization Manager and in partnership with the Insurance Training team, the Insurance Verification & Authorization Supervisor is responsible for developing, documenting, and updating departmental policies, procedures, and metrics. Additionally, the Insurance Verification and Authorization Supervisor will be responsible for interviewing/hiring, evaluating performance, coaching, disciplinary action and daily supervision of the specialists and coordinators to ensure that all department and company policies and procedures are followed.

You are responsible for:

  • Develop, monitor and manage all direct reports

  • Assist in and make recommendations on selection, promotions, merit increases and employee discipline

  • Conduct periodic and annual performance reviews for all direct reports

  • Identify team and individual training/improvement needs and assist in developing plans for immediate and long-term performance improvements

  • Review quality assurance monitoring for all team members on a frequent and ongoing basis to ensure adherence to all department and company policies and procedures

  • Ensure Insurance related tasks are performed accurately, efficiently, and timely by the Insurance Verification & Authorization Team to meet department and company goals

  • Ensure cross training within the department to ensure smooth work flow, functional coverage and staff development

  • Report recurring payer and/or appeal issues to the Insurance Verification & Authorization Manager

  • Ensure effective collaboration with external and internal team members and customers to create a remarkable experience for our customers, maximize reimbursement and business opportunities

  • Foster a positive and rewarding work environment for all team members

  • Under the guidance of the Insurance Verification & Authorization Manager, develop, document, and update departmental policies and procedures

  • Evaluate department metrics to determine areas of success and areas needing improvement

  • Develop and maintain working knowledge of current durable medical equipment (DME) products offered by the company and all applicable insurance guidelines as it relates to eligibility for coverage and reimbursement

  • Act as the Insurance Team liaison to internal and external customers to resolve problems for a timely and effective resolution

  • Support the insurance team by performing duties, when needed. Duties may include but not limited to : handling incoming calls, calling payers for in-depth insurance verifications, working on prior-authorization and letter of agreement requests, calling payers to following up on submitted prior authorization, reviewing and writing appeals, following up with patients or Territory Managers.

You are a part of:

  • Insurance team – RespirTech

To succeed in this role, you should have the following skills and experience:

  • Bachelor’s degree preferred or equivalent leadership experience in a healthcare related industry

  • Minimum 2 years supervisory/management experience

  • Experience working for or with medical insurance companies in a healthcare setting, verifying insurance eligibility and benefit limits and/or submitting and receiving prior authorizations for service

In return, we offer you

Sharpen your talents with new challenges in our dynamic organization. As a market-driven company, we’re used to listening to our customers & apply the same thinking to our employees. We offer a competitive salary, outstanding benefits and flexibility in a career with a positive and supportive atmosphere in which to develop your talents further.

Why should you join Philips?

Working at Philips is more than a job. It’s a calling to create a healthier society through meaningful work, focused on improving 3 billion lives a year by delivering innovative solutions across the health continuum at http://www.philips.com/b-dam/corporate/corporateblog/2016/PhilipsChronicDisease_5.jpg . Our people experience a variety of unexpected moments when their lives and careers come together in meaningful ways.

To find out more about what it’s like working for Philips at a personal level, visit the Working at Philips page at http://www.philips.com/a-w/careers/healthtech/working-at-philips/working-at-philips.html on our career website, where you can read stories from our employee blog at http://www.usa.philips.com/a-w/our-people/life-at-philips.html . Once there, you can also learn about our recruitment process at http://www.philips.com/a-w/careers/healthtech.html , or find answers to some of the frequently asked questions at http://www.philips.com/a-w/careers/healthtech/faq.html .

Philips is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex (including pregnancy), sexual orientation, gender identity, national origin, genetic information, creed, citizenship, disability, protected veteran or marital status.

As an equal opportunity employer, Philips is committed to a diverse workforce. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans' Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants that require accommodation in the job application process may contact 888-367-7223, option 5, for assistance.