Supervisor, Provider Claims Resolution & Recovery
Location: Rancho Cucamonga
Posted on: January 16, 2023
A reasonable salary expectation is between $70,002.40 -
$89,261.33, based upon experience and internal equity.
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
Leader: Administers Hires, Terminations, and Performance
Four (4) years of experience auditing claims in a Managed Care
environment with at least (1) year experience in a supervisory
High school diploma or GED required.
Drivers License Required Yes, must have a valid California Driver's
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
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
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