Supervisor, Claims Operations

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.

Responsibilities

Oversight of external and internal processes related to Claims Adjudication; Compilation and scrubbing of claims data to analyze, track, and trend adjudicated claims; Monitoring TAT compliance, Production, and Error Rate; Preparing mid-month reports for forecasting; Health Plan monthly reporting including ODAG and Part C; Health Plan Universes for Audits; Reports to identify potential recovery; Reports requested by various personnel at AltaMed; Identifying root causes of claims payment errors and reporting to management; Collaborating with other departments and/or providers in resolving claims related issues

Requirements

Associates degree (AA/AS) or Bachelor's degree is highly recommended; Must be knowledgeable of Medi-Cal regulations, Commercial, and Medicare rules and regulations and medical terminology; HS Diploma required; Minimum of 5 years of experience in a managed care environment, claims knowledge preferred; Must have an understanding to read CMS-1500 and UB-04 forms and be able to read and interpret DOFRs and Contracts; Must have strong organizational and mathematical skills

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