Claims Audit Supervisor, FT Days
About The Position
The Supervisor, Claims Audit is responsible for overseeing and managing claims auditors/trainers and ensuring that all policies and procedures are enforced as it relates to health plans and regulatory agencies requirements. This role understands claims payments/processes, compliance, audits, policies and procedures, state and federal regulations, health plan contracts, provider contracts, reimbursement, and audits. Will provide leadership in performance management of claims audits and training. Reports to the Director of Claims. Responsible for the day-to-day management of claims audits, and training of claims examiners. Will ensure that all claims examiners are fully trained and equipped to meet or exceed their productivity, process claims in accordance with contracted and non-contracted providers, and meet health plans' and regulatory agencies' requirements. PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women's health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.
Responsibilities
- overseeing and managing claims auditors/trainers
- ensuring that all policies and procedures are enforced as it relates to health plans and regulatory agencies requirements
- leadership in performance management of claims audits and training
- day-to-day management of claims audits
- training of claims examiners
- ensure that all claims examiners are fully trained and equipped to meet or exceed their productivity
- process claims in accordance with contracted and non-contracted providers
- meet health plans' and regulatory agencies' requirements
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
