Claims Supervisor

National Vision Administrators is seeking an experienced Claims Supervisor to oversee daily operations of the vision eye care claims team. This role ensures accurate and timely Medicaid and Medicare claims adjudication, while maintaining compliance with regulatory requirements and company standards.

In-office onsite 5 days a week in Clifton New Jersey, this is NOT a remote role.

Key Responsibilities

• Supervise claims staff and manage daily workflow
• Review and process complex and high-dollar claims
• Ensure accuracy of medical billing and coding (CPT, ICD-10, HCPCS, modifiers)
• Manage COB/TPL claims and resolve denials/rejections
• Ensure Prompt Pay compliance and regulatory adherence
• Oversee ManageEngine tickets and escalations
• Support audits, reporting, and quality assurance initiatives
• Train and develop team members

Qualifications

• 5+ years of Medicaid/Medicare claims processing and adjudication experience
• Strong knowledge of: 
  • CPT, ICD-10, HCPCS, modifiers
  • CMS-1500 (HCFA 1500) forms and electronic billing
  • Timely filing, resubmissions, appeals, and remittance advice
• Experience with COB/TPL and denied claims resolution
• Familiarity with AS400 or similar claims systems
• Strong Excel and Microsoft Office skills
• Excellent communication and organizational skills
• CPC, CPB, or CBC certification is preferred
• Prior experience in vision plans, optometry, ophthalmology, or eye care billing is preferred

Company Benefits:

• Vacation and Sick/Personal Time
• Medical Insurance / Prescription / Vision / Dental
• Hearing Program Discount
• Short- & Long-Term Disability Insurance
• Life Insurance
• Flexible Spending Account
• 401(k) plus company match
• Employee Referral Program
• Employee Recognition
• Tuition Reimbursement
• Professional Development Training