Supervisor, Provider Claims Resolution & Recovery

*Job Overview*The Supervisor, Provider Claims Resolution & Recovery - Claims monitors daily activity of assigned inventories, including disputes, appeals, adjustments, special projects, and outgoing correspondence. Reviews special projects and delegate to appropriate units for processing. Supervises Claims Appeals Resolution team members including questions, productivity, quality, attendance, and performance evaluations. Establishes and delegates work assignments according to team member job specifications and business needs. Assists with handling escalated phone calls, adjustments, disputes, appeals, or training needs as required. Identifies trends in dispute and or payment issues and facilitate internal awareness to initiate a coordinated effort across claims units for education and improvement of accuracy. Communicates with Providers regarding claims payment inquiries, disputes, or appeals. Generates daily/periodic inventory control reports, regulatory reporting compliance. Coordinate with other IEHP departments to facilitate resolution of claim-related issues. Identify and report claim-related billing issues to various departments for follow-up provider education. Regulatory audit preparation and research complex claims as needed.Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.*Education & Requirements ** Four (4) years of experience in a Managed Care environment in the areas of claims processing, and or provider payment appeals and disputes, with at least one (1) year in a supervisory capacity.* High School Diploma or GED required.*Key Qualifications** Must have a valid California Driver's License.* Extensive knowledge of ICD9, CPT and Revenue Codes. Knowledgeable in CMS, DHMC and DHCS regulatory guidelines, including AB1455. Principles and techniques of supervision and training. A thorough understanding of claims industry and customer service standards.* Strong analytical and problem-solving skills. Microsoft Office, Advanced Microsoft Excel. Analytical skills with emphasis on time management, database maintenance, spreadsheet manipulation, and problem solving. Strong writing, organizational, project management proficiency required. Must have excellent interpersonal and communication skills.* Medi-Cal program and benefit requirements experience desired. HMO or Managed Experience preferably in an HMO or Managed Care setting. Medicare and/or Medi-Cal experience preferred. Prior experience in a lead role or customer service environment is a plusJob Type: Full-timePay: $80,059.20 - $106,059.20 per yearBenefits:* 401(k)* 401(k) matching* Dental insurance* Health insurance* Life insurance* Paid time off* Vision insuranceSchedule:* 8 hour shiftWork Location: Hybrid remote in Rancho Cucamonga, CA 91730

Created: 2025-01-30