Description

Are you a detail-oriented healthcare professional with a passion for ensuring accurate and timely provider payments? Do you thrive in a leadership role where you can mentor a team and make a real difference in the healthcare system? If so, this exciting opportunity to join a mission-driven organization might be your perfect fit!

We’re looking for a dynamic and experienced Supervisor to lead our Provider Claims Resolution & Recovery team. You’ll be the champion for fair provider payments, overseeing the daily activities of your team and ensuring the smooth resolution of claims disputes, appeals, and adjustments. If you’re a problem-solver with strong analytical skills and a knack for communication, we encourage you to apply!

Compensation and Benefits

• Competitive Pay: \(80,059.20 - \)106,059.20 per year.
• Comprehensive Benefits: 401(k) with matching, dental insurance, health insurance, life insurance, paid time off, and vision insurance.
• Work-Life Balance: 8-hour shifts.
• Hybrid Work: Enjoy a hybrid work arrangement in Rancho Cucamonga, CA.

Why you should apply for this position today

This role offers a unique opportunity to make a significant impact in the healthcare system. By joining our team, you’ll be part of a mission-driven organization that values mentorship, collaboration, and the pursuit of excellence in provider payments.

Skills

• Extensive knowledge of ICD9, CPT, and Revenue Codes.
• Knowledge of CMS, DHMC, and DHCS regulatory guidelines, including AB1455.
• Strong analytical and problem-solving skills.
• Proficiency in Microsoft Office, especially advanced Excel.
• Excellent writing, organizational, and project management skills.
• Excellent interpersonal and communication skills.

Responsibilities

• Supervise and mentor the Claims Appeals Resolution team, providing guidance, support, and performance evaluations.
• Establish and delegate work assignments based on team member skills and business needs.
• Monitor daily activity of assigned inventories, including disputes, appeals, adjustments, special projects, and correspondence.
• Handle escalated phone calls, adjustments, disputes, appeals, and training needs as required.
• Identify trends in dispute and payment issues and collaborate with internal teams to improve accuracy.
• Communicate with providers regarding claims payment inquiries, disputes, or appeals.
• Generate daily/periodic inventory control reports and ensure regulatory reporting compliance.
• Coordinate with other departments to resolve claim-related issues.
• Identify and report claim-related billing issues to various departments for provider education.
• Assist with regulatory audit preparation and research complex claims as needed.

Qualifications

• Four (4) years of experience in a managed care environment in claims processing and/or provider payment appeals and disputes, with at least one (1) year in a supervisory capacity.
• High School Diploma or GED.
• Valid California Driver’s License.
• Understanding of supervisory and training principles and techniques.
• Thorough understanding of claims industry and customer service standards.

Education Requirements

• High School Diploma or GED.

Education Requirements Credential Category

• High School Diploma or GED.

Experience Requirements

• Four (4) years of experience in a managed care environment in claims processing and/or provider payment appeals and disputes.
• At least one (1) year in a supervisory capacity.

Why work in Rancho Cucamonga, CA

Rancho Cucamonga offers a beautiful community with scenic views and a comfortable climate, making it an ideal location for both work and leisure. The city provides a variety of recreational activities, shopping centers, and dining options. With its proximity to Los Angeles, residents can enjoy the vibrant cultural scene while still having the charm of a suburban lifestyle.