Supervisor, Provider Claims Resolution & Recovery - Recovery

Date: Jul 19, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5174 

 

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.

Preferred Experience

Education Qualifications

 

High school diploma or GED required.

Preferred Education

Professional Certification

Professional Licenses

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.

Abilities Requirement

 

Ability to prioritize and execute tasks in a high-pressure environment. Strong analytical and problem-solving skills. Exceptional time management, project management, writing, and communication skills required.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Sedentary work in an office enviornment.

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Use of computer mouse - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Communicate: Verbally engage with customer base - FREQUENTLY
Use hands/fingers to handle or feel - FREQUENTLY
Fine manipulation - FREQUENTLY
Simple Grasp - FREQUENTLY
Lighting - CONSTANTLY
Near Visual Acuity - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Decision-making - FREQUENTLY
Lead/Influence Others - FREQUENTLY
Control of work pace - FREQUENTLY
Problem Solving - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY
Indoors - CONSTANTLY
Alternate Sit/Stand or Walk at Will - FREQUENTLY
Sitting - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Hearing: In a group - FREQUENTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY
Turning/rotation of wrist or hand - FREQUENTLY
Perform complex and varied tasks - FREQUENTLY
Develop and maintain positive work relationships - CONSTANTLY
Work review - FREQUENTLY
Rapid Pace of work - FREQUENTLY

 

Starting Salary: $66,040.00  -   $84,219.20 

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles