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Partnership HealthPlan of California · 1 day ago

Claims Resolution Supervisor

Sonoma County, CA

Full-time

Onsite

Mid, Senior Level

$94K/yr - $117K/yr

2+ years exp

Partnership HealthPlan of California is focused on delivering high-quality service in the Medi-Cal sector, and they are seeking a Claims Resolution Supervisor to oversee customer service outreach functions. The role involves developing training materials for medical providers, preparing reports, and collaborating with various teams to resolve provider issues and improve communication.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Coordinates with Claims Resolution Coordinators (CRCs) to develop provider educational/training materials for all Partnership lines of

Prepares a quarterly and monthly plan of action for the Director, identifying key provider outreach targets and plan of

Prepares production statistics and related reports for the Director’s review

Collaborates with Claims Customer Service Manager to identify provider abrasion issues

Leads group provider trainings or individual provider settings

Reviews monthly reports and tracks claims trends for provider educational opportunities

Presents to Director with findings and recommendations for ongoing, long term resolutions

Identifies items to address the 'provider hassle factor.'

Prepares a post-visit report for Director to include visit results, expectations of provider and Partnership, with required follow-up plan

Reviews, strategies and tactics for more effective communication to provider billing staff with CRC

Recommends changes for more efficient communication

Reports system issues to Claims Configuration staff and/or IT

Assists Provider Relations Manager and Representatives in the review, research, and resolution of complex provider inquiries, appeals, and

Coordinates with CRCs, Claims, and Provider Relations, the development and maintenance of ongoing educational materials and tips for inclusion on the Partnership

Reviews and drafts PR newsletter articles related to claims issues identified during provider training and research

Interviews and participates in the selection of qualified candidates for CRCs

All other duties as assigned

Leads or participates in special projects and assignments as needed

Participates in provider meetings, both on and off site as required

Qualification

CPT codingICD-9 codingHCPCs codingClaims procedures expertiseMedical terminologyJudgmentOral communicationWritten communicationInterpersonal skillsOrganizational skills

Required

High School diploma or equivalent

Minimum two (2) years of supervisor experience in a claims environment or equivalent combination of education and experience

Thorough knowledge of CPT, HCPCs procedure coding, and ICD-9 diagnostic coding

Knowledge of medical terminology

Expertise in automated claims procedures and related problems resolution

Typing speed 30 wpm and proficient use of 10-key calculator

Valid California driver's license and proof of current automobile insurance compliant with Partnership policy

Excellent oral and written communication skills

Excellent interpersonal skills with ability to lead and manage staff to effectively complete assignments within established timeframes and standards

Ability to effectively exercise good judgment and handle sensitive issues with frequent interruptions

Good organization skills

Ability to work in a fast-paced environment and maintain courtesy and composure when dealing with internal and external customers

Ability to move, carry, or lift objects of varying size, weighing up to 10 lbs

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994

Fairfield, California, USA

1001-5000 employees