Claims Supervisor will be responsible for assisting Claims Manager in overseeing the Claims Department. Responsibilities include, but not limited to: • Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including: Contractual agreement rates Health Plan procedures Medicare and Medi-cal reimbursement Claims processing guidelines Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, process, and adjusting claims Authorizes the appropriate payment or refer claims for further review Respond and resolve providers' and health plans' inquires in a timely manner Provide support to Configuration to ensure accuracy Coordinate with Compliance department to process claims accordingly to Health Plan requirements. Support Compliance department in Health Plan audits Help identify issues from audit findings and develop action plans to resolve Supervise and monitor Claims staff production and guide them for improvements Provide additional training to Claims staff for efficient processing as needed Ensure check runs are ready according to schedule Attend meetings as required Report to Claims Manager Other duties as needed Qualifications: Bachelor's degree in related field Minimum of one year in a managerial position Must have at least 5 years of applicable healthcare claims adjudication experience within a managed care industry Must be familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing. Must be familiar with facility (UB-04) and professional (CMS-1500) claim billing practices. Must have good written and communication skills. Must have managerial and risk management skills Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment. Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. Typing skills of at least 40 wpm. Exempt and on-site position. Benefits: Medical Insurance Dental Insurance Vision Insurance Paid Time Off 401K Matching
