Claims Reg Comp, Supervisor

MemorialCare Health System • Fountain Valley, CA

77d • $30 - $44

About The Position

Under minimal supervision and in a professional and friendly manner, performs all assigned job tasks to the highest level of accuracy and timeliness. The role supports the supervision of Claims Compliance production staff, administrative personnel, and mailroom operations, ensuring efficient receipt and distribution of incoming mail. It requires a strong understanding of outpatient facilities and professional claim processing, including comprehensive knowledge of CPT, HCPCS, ICD-9 coding, and various reimbursement methodologies such as Medicare Fee Schedules, case rates, APC, ASC, and Medi-Cal. The position also demands expertise in interpreting and applying the Division of Financial Responsibility (DOFR) for Managed Care contracts. Additionally, the role contributes to regulatory audit preparation and execution, provides leadership within the unit, prioritizes daily activities, and monitors inventory aging to maintain operational efficiency and compliance.

Requirements

• At least 5 years claims processing experience
• 3 years claims regulatory audits
• Minimum 2 years supervisory experience
• Knowledge of regulatory requirements: CMS, DMHC
• Strong written and verbal communication skills
• Working knowledge of Microsoft applications - Word, Excel
• Ability to work well with others
• Demonstrates professionalism in appearance and demeanor
• Flexibility in work schedule

Responsibilities

• Prepare and maintain compliance inventory reports and manage assignment of work assignments, including exercising authority when appropriate, to allocate resources and direct activities to departmental advantage
• Prepare and maintain regulatory reports and supporting attestations
• Assign, manage, and/or handle special projects delegated by manager or senior management and keep the manager informed when problems may interfere with work being completed on time
• Develop and incorporate quality control measures into the daily work flow
• Develop and maintain templates, forms, reports, and other tools to assist in monitoring timeliness and payment accuracy and health plan regulatory audit success
• Coordinate closely with Compliance & Manager on quality performance
• Prepare and maintain clerical production reports
• Respond appropriately to team questions and concerns and identify issues for training opportunities
• Interface with other departments to resolve Compliance issues
• Develop methodologies for identifying root cause errors that surface through claims audits
• Participate in quality improvement activities for departmental and unit-specific processes
• Participate in the training of new employees and offer guidance and assistance to educate staff
• Participate in reviewing, revising, and developing policies and procedures for the department
• Complete performance evaluations, coach, counsel and/or discipline employees as necessary to improve performance
• Assist in monitoring time and attendance
• Assume responsibilities of Claims Regulatory Audit Manager in his/her absence
• Be at work and be on time
• Follow company policies, procedures and directives
• Interact in a positive and constructive manner
• Prioritize and multitask

Benefits

• High quality health insurance plan options
• Shift differentials
• Extra shift incentives
• Bonus opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: High school or GED