Supervisor, Provider Claims Resolution & Recovery

Company: IEHP
Location: Rancho Cucamonga
Posted on: January 16, 2023

Job Description:

A reasonable salary expectation is between $70,002.40 - $89,261.33, based upon experience and internal equity.
Position Summary/Position
The Provider Claims Resolution & Recovery Supervisor is responsible for the direct supervision of the Claims Recovery team. The Supervisor will ensure that all department activities are appropriately staffed and supervised. The Supervisor will oversee the appropriate application of refund checks, recovery requests and provider disputes and ensure they are sent to Providers within State and Federal regulatory requirements.
Major Functions (Duties and Responsibilities)
1. Review monthly reporting packages and ensure data validity is maintained.2. Monitor daily inventory activity to effectively manage fluctuations to ensure quality standards are achieved.3. Supervise and develop staff to meet performance goals and collaborate with Management to resolve performance barriers or perform root cause analysis.4. Supervise team members including monitoring production, quality, attendance and completing formal Introductory/Annual performance evaluations.5. Assist with handling escalated phone calls & disputes and training needs as required.6. Assist with the implementation and management of any third-party vendors contracted for recovery or subrogation.7. Recognize trends in recovery requests, refunds and audits and facilitate recommendations for quality improvement.8. Assist Manager in identifying and eliminating waste, duplication, inefficiency, and manual efforts and provide input on events that have undergone process improvement initiatives within the department.9. Coordinate, prepare, and monitor special projects as needed.10. Assist the Manager, Provider Claims Resolution & Recovery in the development and maintenance of P&Ps regarding auditing procedures.11. Attend key strategic committees that are necessary to maintain a viable knowledge base within 12. Promote teamwork and maintain effective working relationships with others throughout the organization.
Supervisory Responsibilities
Leader: Administers Hires, Terminations, and Performance Reviews
Experience Qualifications
Four (4) years of experience auditing claims in a Managed Care environment with at least (1) year experience in a supervisory role.
Education Qualifications
High school diploma or GED required.
Drivers License Required Yes, must have a valid California Driver's License.
Knowledge Requirement Solid understanding of CMS, DHCS and DMHC rules and regulations that govern claims payment practices and procedures. Key principles and techniques of supervision and training.
Skills Requirement
Intermediate level of Excel and Word, advanced knowledge of research protocols. Strong analytical and problem-solving skills and contract interpretation. Excellent communication and interpersonal skills. Strong organizational skills, effective writing and communications skills and computer proficient.

Keywords: IEHP, Rancho Cucamonga , Supervisor, Provider Claims Resolution & Recovery, Other , Rancho Cucamonga, California