Supervisor, Claims Operations
About The Position
The Claims Operations Supervisor is responsible for the oversight of external as well as internal processes as it relates to Claims Adjudication. This includes the compilation and scrubbing of claims data to analyze, track, and trend various aspects of the adjudicated claims. This includes but is not limited to, TAT compliance, Production, Error Rate, mid-month reports for forecasting, Health Plan monthly reporting including ODAG and Part C, Health Plan Universes for Audits, reports to identify potential recovery, as well as reports requested by various personnel at AltaMed. The Claims Operations Supervisor will identify root causes of claims payment errors and reports to management as well as collaborates with other departments and/or providers in successful resolution of claims related issues.
Requirements
- High School Diploma required.
- Knowledgeable of Medi-Cal regulations, Commercial, and Medicare rules and regulations.
- Knowledgeable of medical terminology.
- Minimum of 5 years of experience in a managed care environment.
- Claims knowledge preferred.
- Understanding to read CMS-1500 and UB-04 forms.
- Ability to read and interpret DOFRs and Contracts.
- Strong organizational skills.
- Strong mathematical skills.
Nice To Haves
- Associate degree (AA/AS) or Bachelor’s degree is highly recommended.
Responsibilities
- Oversight of external and internal processes related to Claims Adjudication.
- Compilation and scrubbing of claims data to analyze, track, and trend adjudicated claims.
- Generate reports including TAT compliance, Production, Error Rate, mid-month reports for forecasting, Health Plan monthly reporting (ODAG and Part C), Health Plan Universes for Audits, and potential recovery identification.
- Identify root causes of claims payment errors.
- Report findings to management.
- Collaborate with other departments and/or providers for claims-related issue resolution.
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
