Job Description
We are seeking a dynamic and results-oriented Supervisor, Provider Claims Resolution & Recovery to join our team! In this key role, you will lead and mentor a team of professionals, ensure the timely and accurate resolution of provider claims, and contribute to the overall success of our organization.
What you'll do:
Lead and mentor a high-performing team: Supervise the daily activities of team members, providing guidance, support, and performance feedback.
Ensure timely and accurate claim resolution: Monitor and resolve complex claims disputes, appeals, and adjustments.
Drive process improvement: Identify trends and issues within the claims resolution process and implement solutions to improve efficiency and accuracy.
Communicate effectively: Communicate with providers, internal departments, and other stakeholders to resolve claim-related issues.
Ensure regulatory compliance: Stay informed of and ensure compliance with all relevant regulations, including CMS, DHMC, and DHCS guidelines.
Contribute to team success: Foster a positive and collaborative work environment that supports team growth and development.
What you'll bring to the table:
Proven experience in healthcare claims: At least four years of experience in a Managed Care environment, with a focus on claims processing, provider payment appeals, and disputes.
Leadership experience: At least one year of supervisory experience.
Strong analytical and problem-solving skills: Ability to analyze complex data, identify trends, and develop effective solutions.
Excellent communication and interpersonal skills: Ability to effectively communicate with a diverse range of stakeholders, both internally and externally.
Strong organizational and time-management skills: Ability to prioritize tasks, meet deadlines, and manage multiple projects1 simultaneously.
1.
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Proficiency with Microsoft Office Suite, with advanced Excel skills.
High School Diploma or GED.
Bonus points for:
Experience with Medi-Cal and/or Medicare programs.
Experience in an HMO or Managed Care setting.
Knowledge of ICD-9, CPT, and Revenue Codes.
Why join our team?
Join a mission-driven organization: Contribute to the health and well-being of our members and make a real impact on our community.
Enjoy a competitive benefits package: Receive competitive pay, comprehensive health insurance, and a generous benefits package.
Experience professional growth: Develop your leadership skills and advance your career within a growing organization.
Work in a hybrid environment: Enjoy the flexibility of a hybrid work arrangement.
Ready to lead and make a difference?
If you are a highly motivated and results-oriented Supervisor with a passion for healthcare and a commitment to excellence, we encourage you to apply!
Note:
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Employment Type: Full-Time
Salary: $ 80,059.00 Per Year
Job Tags
Full time, Remote job,