Claims Supervisor

REPORTS TO: Director of RCM Operations

EMPLOYMENT STATUS: Full-Time

CLASSIFICATION: Exempt

LOCATION: 1000 NW 65TH STREET FORT LAUDERDALE FL, 33309 SUTE 300D

WORK LOCATION: On Site

WORK HOURS: 8:00AM-4:30PM EST Monday-Friday

Job Summary:

The Claims Supervisor at CodeMax is responsible for overseeing the daily operations of the claims team, ensuring timely and accurate claim submissions, reducing denials, and optimizing reimbursement processes. This role involves supervising claims team lead, implementing best practices for claims management, and working closely with payers to resolve outstanding claims efficiently.

Key Responsibilities:

1. Team Leadership & Supervision

• Lead and manage team of claims representatives to ensure optimal performance
• Monitor workloads and productivity, ensuring all claims are processed within required timeframes
• Provide training and ongoing support to claims staff, addressing knowledge gaps and improving efficiency.

2. Claims Processing & Accuracy

• Ensure timely and accurate claims submission in accordance with payer requirements and industry regulations.
• Monitor claims scrubbing processes to minimize rejections and denials
• Oversee claims corrections, resubmissions, and appeals for denied claims

3. Denials & AR Management

• Analyze denial trends and implement strategies to improve claim acceptance rates
• Collaborate with the Appeals and AR teams to resolve outstanding claims and negotiate underpayments
• Ensure follow-up on all unpaid claims over 30 days and escalate problematic claims as needed

4. Compliance & Quality Assurance

• Ensure claims processing align with HIPAA, payer guidelines, and regulatory compliance requirements
• Conduct audits of claims and team performance to maintain accuracy and compliance
• Work closely with the coding and clinical documentation teams to prevent claim denials due to documentation errors

5. Reporting & Process Improvement

• Generate weekly and monthly reports on claims volume, denial rates and AR aging for management review
• Identify bottlenecks in claims workflows and implement process improvements
• Collaborate with billing, VOB, and UR teams to optimize revenue cycle efficiency.

Key Performance Indicators (KPI's):

• 95%
Denial Rate:
• 10%
AR Days Outstanding:
• 30 days
Appeal Success Rate:
• 75%
Claims Submission Turnaround:
• 48 hours post-service

Qualifications & Experience:

Education:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred
• Equivalent work experience in RCM or medical billing/claims will be considered

Experience:

• 3-5 years of experience in medical clams processing, billing, or revenue cycle management
• 1-2 years in supervisory or leadership role within claims or AR
• Strong knowledge of payer guidelines, insurance contracts, and reimbursement models (Medicare, Medicaid, Commercial).

Skills & Competencies:

• Claims & Denial Management Expertise - Ability to identify trends and implement corrective actions.
• Leadership & Team Development – Proven ability to coach and develop high-performing teams.
• Analytical & Problem-Solving Skills – Strong ability to analyze AR and claim data to drive improvements
• Communication & Negotiation Skills - Ability to interact professionally with payers, clients and internal teams
• Technical Proficiency – Experience with RCM software, payer portals and EHR systems