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Claims Supervisor

Location : 600 City Parkway, Orange CA
Job Type : Direct
Reference Code : 22166
Required Years of Experience : 5
Job Industry : Healthcare - Health Services

Job Description :

Claims Supervisor



The position is 100% on-site at our Orange office:




600 City Parkway West, Suite 800 Orange, CA 92868










Min 54,976 Mid 68,720, Max 82, 464




 

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.


Monitors day-to-day claims inventory to ensure all CMS and DMHC regulatory guidelines are met. Serves as direct Supervisor to claims personnel. Has direct responsibility for overseeing all claims processing functions for all LOB, both Profession and Institutional.  Identifies and adopts appropriate solutions and changes necessary to establish and maintain high levels of quality and service.   Motivate and counsel staff when necessary. Also responsible for coordinating inventory and mailroom resources to fulfill and process all incoming mail. Responsible for supervising the inventory and mail staff to meet established performance measures for timely processing. Selects develops and evaluates personnel to ensure the efficient operation of the functions.




Job Responsibilities/Duties



  • Monitors daily inventory Dashboards to ensure that departmental goals are met. Works with Director to plan daily workflow.  Reviews and approves High Dollar claim payments to providers daily.  Provides management with feedback of overall inventory compliance. 

  • Oversee daily mailroom activities including sorting, batching of incoming mail, as well as preparation and sending of outgoing mail to our scanning vendor. 

  • Ensure the preparation of medical records/Appeals for in our in-house scanning vendor.  

  • Ensure PDRs are looked up and batched appropriately for the PDR Team.

  • Oversees and directs the day-to-day operations of the Data Entry staff.  

  • Ensures adequate staffing levels are always maintained.

  • Provide weekly reports to upper management on the status of the Mail Room.

  • Train and develop Mail Room employees to work as a team.

  • Coaching and developing existing staff. 

  • Oversight of Team performance metrics. 

  • Do weekly one on ones with staff.

  • Provides written communication to other departments as needed regarding pended claims inventory.

  • Prioritizing and distribution of work to claims staff.    

  • Monitor production to ensure claim production standards and quality standards are being met. 

  • Answers claim questions for staff. 

  • Responsible for accurate file management, archiving and storage PDRs and medical records for 90 days. 

  • Responsible for coordination with Facilities Director of vendor shredding and the security associated with the protection of records to be shredded.

  • Prepares and conducts Performance Reviews and Disciplinary Action for staff. 

  • Identifies ways to control cost by evaluating, analyzing, and researching payment trends and variances.

  • Recommends policies and procedure changes regarding claim payment processing. 

  • Handles other duties as needed.


 


Required Qualifications :

Qualifications


 

Minimum Education:


 Bachelor’s Degree preferred or High School diploma with two to three (2-3) years claims Management experience.


 


Minimum Experience:



  • Minimum experience of 5 years Management Exp.

  • 100% on-site  (Must be fully vaccinated)

  • Has Managed at least a minimum of 10 – 15 associates.

  • IDX Exp a Plus but not a deal-breaker.

  • Good Analytical skills

  • Good communication skills.

  • Good Coaching and listening skills.

  • Experience writing performance evaluations.

  • 1-year minimum exp managing a mailroom.

  • Minimum experience in Health Care for all lines of business (Medicare, Commercial, Medi-cal)

  • Knowledge of all HIPPA regulations.

  • Good working knowledge of all regulatory guidelines turnaround times for all lines of business.

  • PC skills, knowledge of word processing/spreadsheet applications.

  •  Working knowledge of workflows.

  •  Five years’ experience in an IPA or MSO setting required. 

  • IDX experience is highly desirable.


Req. Certification/Licensure: None.


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