Integrity​/SIU Technical Coordinator

Overview

Health Partners is hiring a Payment Integrity/SIU Technical Coordinator. Provide technical supervision and work direction to staff. Assumes the role of unit supervisor in the absence of the supervisor. Organize and oversee the expedient and accurate adjudication of claims. Provide direction, guidance and support necessary to bring about individual development in line with individual needs and department objectives. Serve as a project leader in the use, development, implementation and enhancement of systems, and coordinate the activities of all affected areas.

• Supervision:
  Assist in the selection, development and supervision of staff to ensure achievement of department objectives. Select and motivate a competent workforce. Assume the role of supervisor in the absence of the supervisor, including signing timecards, hiring and firing decisions, union issues and time off approval.
• Technical Competence:
  Develop staff technical competence to ensure maximum production and quality standards. Design and revise procedures as necessary to facilitate efficient claims processing. Prepare, conduct and analyze system and user audits to ensure new, promoted and existing employees  technical competence, to heighten production and quality standards, improve and maximize system use. Provide follow up support through evaluation sessions with each staff member.
• System Expert:
  Support staff in identifying potential improvements in automated or manual processes. Provide expertise in training of system functionality including all modules of the claims system and DEC applications (auths, supplemental insurance, claims processing, online benefits, membership systems, HCSS, etc.). Investigate claims problems and assist in their resolution. Conduct training of new examiners and remedial training of experienced examiners as needed.
  
  Perform benefit interpretation to define and facilitate development of procedures resulting from implementation or revision of claims processes. Maintain a current knowledge base and utilize new training techniques and documentation. Ensure efficiency, eliminate redundancy, and utilize other administrative resources for claims processing needs.
• Data Interpretation:
  Ensure data quality through an audit process to meet expected standards of system users. Facilitate management assimilation of data by interpreting reports and highlighting trends. Determine quantity of claims required for auditing of each examiner. Audit and authorize payment of claims over examiner s limits.
• Support:
  Support unit, departmental and divisional teams through participation in and appropriate meetings and projects. Coordinate all processes affected by the project to capture complete information for training documentation and implementation. Interact with other supervisors and their personnel from other departments or organizations to resolve mutual problems. Participate in departmental planning and redesign.
• Other Duties:
  Perform additional duties, attend meetings and assume projects as assigned by supervisor, manager or director.

• Bachelor s degree with at least two years of claims experience in the administration of insurance benefits, or Associate degree with two years of Health Partners experience. Education requirement may be waived based on a minimum of four years of claims processing experience with demonstrated technical expertise.
• Advanced analytical and problem solving ability.
• Working knowledge of Health Partners mainframe systems or equivalent experience with other claims systems.
• Effective presentation, planning, oral and written communication skills with the ability to communicate at all levels of the organization and with external customers.
• Detailed knowledge and understanding of the insurance industry including claims processing and customer service expectations.
• Able to interpret and explain provider and member/employer contracts.
• Must be highly flexible, able to handle and manage a high degree of change.
• Able to work independently and as a team player.
• Knowledgeable of total quality management concepts.
• Able to identify individual training needs and provide appropriate instruction.