Supervisor, Provider Claims Resolution & Recovery - Finance (Hybrid)

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

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

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