CNSI delivers a broad range of health information technology enterprise solutions and customizable products to a diverse base of state and federal agencies. We align, build, and manage innovative, high-quality, cost-effective solutions that help customers achieve their mission, enhance business performance, reduce costs, and improve health for over 51 million Americans.

CNSI is empowering the delivery of public sector healthcare in claims and encounter processing platforms, provider support solutions, and promoting consumer engagement and interoperability. Our technology-enabled products and solutions connect consumers, payers, and providers to improve health outcomes for one in five Americans.

Summary:

The Resolution and Adjustment Supervisor manages resolution and adjustment specialists that conduct bill-specific research to resolve outstanding issues. The Resolution and Adjustment Supervisor provides guidance to specialists in a variety of duties.

To learn more about us, check us out at www.cns-inc.com

Press Release: https://bit.ly/3vEZSvg

Job Responsibilities:

• Research bill issues to identify root causes and determine corrective actions to resolve issues, communicate findings, and document findings for future use
• Request additional information needed to complete adjudication of bills
• Review bills for necessity, limitations, and exclusions based on bill policies and procedures
• Assist internal associates with bill-related questions and issues
• Identify recurring problems and providing feedback to management to affect change
• Make the appropriate payment adjustment into the claims system
• Complete data entry for tracking and reporting claim disputes
• Adjudicate claims and adjustments that are identified as sensitive
• Act as a trouble-shooter to resolve claim processing problems among internal departments, including authorization issues
• Assist in providing daily guidance for associates to obtain optimal results and to ensure all SLA and timeliness standards are met
• Handle all types of requests, inquiries, and complaints accurately and timely
• Monitor team members' daily productivity goals and provide feedback where necessary
• Provide reinforcement training for new and existing associates as needed
• Help identify system/benefit errors by completing protocols and workflows to prevent future errors
• Complete performance reviews and staff coaching
• Provide ongoing training with staff
• Ensure the Medical Terminology course is completed by all staff members

Required Experience/Skills:

• Bachelor’s degree in Healthcare, Business, or other related scientific or technical disciplines, with recent experience of at least:
  • 5 years in medical bill processing or a similar environment
  • 3 years of experience in Resolution and Adjustment conducting bill-specific research to resolve outstanding issues (may overlap with other experience)
• 1 year in a leadership role managing resolution and adjustment specialists that conduct bill-specific research to resolve outstanding issues (may overlap with other experience

OR

• High School diploma or GED equivalent, with recent experience of at least:
  • 8 years in medical bill processing or a similar environment.
  • 5 years of experience in Resolution and Adjustment conducting bill-specific research to resolve outstanding issues (may overlap with other experience)
• 3 years in a leadership role managing resolution and adjustment specialists that conduct bill-specific research to resolve outstanding issues (may overlap with other experience)

AND

• General knowledge of Workers Compensation and medical terminology
• Familiarity with medical bill forms, ICD-9/10-CM coding, CPT coding, bill forms, and other medical coding schemes (Certification desired)
• Ability to simultaneously maneuver through various computer claims and eligibility platforms while verifying information while on the telephone

About Us:

At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.

Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun! You will be offered a competitive compensation and benefits package.

CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.

Kindly inquire during the interview process if this position is subject to President Biden’s Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, requiring you to be vaccinated by December 8, 2021.