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Claims Medi-Cal Supervisor, Fairfield, CA


Organization: Partnership HealthPlan of California
Category: Supervisor
Location: Fairfield, CA
Date Job Posted: July 29, 2020
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Claims Medi-Cal Supervisor

Job ID 2020-1816
FLSA Status Exempt

Overview

To supervise the Medi-Cal Claims Specialists and Examiners. Ensures delivery of highest level of customer service to the community and its medical providers.

Responsibilities

  • Supervises the Medi-Cal claims specialists and examining staff. Daily supervision of the claims workflow. Supports claim examining and specialist functions. Maintains claim inventories within established goals.
  • Interviews and participates in the selection of qualified candidates for the Medi-Cal claims specialist and examining positions. Evaluates performance and provides developmental opportunities to staff. Provides training of new staff as appropriate. Counsels performance problems or issues when needed. Reviews and signs time cards.
  • Reviews quality control audits with staff to ensure compliance within established department guidelines, policies and procedures. Identifies errors and deficiencies; develops and implements corrective action and training plans for staff.
  • Reviews department policies and procedures, recommends changes for more efficient operations, communicates changes and updates to staff when appropriate.
  • Monitors and maintains pended claims within established department guidelines. Reviews and researches reasons for the lags related to pended claims.
  • Reviews and maintains Batch Error reports within established department guidelines.
  • Reviews Medi-Cal RAs weekly. Prepares production statistics and related reports for the Manager’s/Director’s review.
  • Reviews and signs claim adjustments and high dollar claims within established guidelines.
  • Other duties as assigned.

Qualifications

Education and Experience

Bachelor’s degree in related field preferred; minimum three (3) years supervisor experience in a claims environment; or equivalent combination of education and experience; prior Medi-Cal claims experience preferred.

Special Skills, Licenses and Certifications

Thorough knowledge of CPT, HCPC 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 preferred. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Excellent interpersonal skills with ability to lead and supervise staff to effectively complete assignments within established time frames and standards. Ability to effectively exercise good judgment and handle sensitive issues with frequent interruptions. Good organization skills.

Work Environment And Physical Demands

Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers. More than 70% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 10 lbs.

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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