Claims Supervisor Job at Health Source MSO in Los Angeles County

Claims Supervisor will be responsible for assisting Claims Manager in overseeing the Claims Department. Responsibilities include, but not limited to: • Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including:  Contractual agreement rates  Health Plan procedures  Medicare and Medi-cal reimbursement  Claims processing guidelines Providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, process, and adjusting claims Authorizes the appropriate payment or refer claims for further review Respond and resolve providers’ and health plans’ inquires in a timely manner Provide support to Configuration to ensure accuracy Coordinate with Compliance department to process claims accordingly to Health Plan requirements. Support Compliance department in Health Plan audits Help identify issues from audit findings and develop action plans to resolve Supervise and monitor Claims staff production and guide them for improvements Provide additional training to Claims staff for efficient processing as needed Ensure check runs are ready according to schedule Attend meetings as required Report to Claims Manager Other duties as needed Qualifications: Bachelor’s degree in related field Minimum of one year in a managerial position Must have at least 5 years of applicable healthcare claims adjudication experience within a managed care industry Must be familiar with ICD-10, HCPCS, CPT coding, APC, ASC, and DRG pricing. Must be familiar with facility (UB-04) and professional (CMS-1500) claim billing practices. Must have good written and communication skills. Must have managerial and risk management skills Must be able to follow guidelines, multi-task, and work comfortably within a team-oriented environment. Computer literacy required, including proficient use of Microsoft Word, Excel, Outlook, and EZ-CAP. Typing skills of at least 40 wpm. Exempt and on-site position. Benefits: Medical Insurance Dental Insurance Vision Insurance Paid Time Off 401K Matching

In Summary: Claims Supervisor will be responsible for assisting Claims Manager in overseeing the Claims Department . Responsibilities include: Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes . Support Compliance department in Health Plan audits .

En Español: El Supervisor de Reclamaciones será responsable de ayudar al Gerente de Reclamos a supervisar el Departamento de Reclamo. Las responsabilidades incluyen, pero no se limitan a: • Mantener un conocimiento actualizado de los procedimientos para todos los códigos ICD-10, CPT y HCPC incluyendo: Tarifas de acuerdo contractual Procedimientos del Plan de Salud Medicare y reembolso médico Directrices de procesamiento de reclamos Proporcionar experiencia o apoyo general a los equipos en la revisión, investigación, investigación, negociación, proceso y ajuste de las reclamaciones Autoriza el pago adecuado o reclamaciones para una mayor revisión Responder y resolver los proveedores y planes de salud Encuestas oportunas proporcione soporte a la configuración para garantizar la exactitud Coordinar con los reclamos de atención médica según los requisitos del plan de salud. Debe estar familiarizado con las prácticas de facturación de reclamos en instalaciones (UB-04) y profesionales (CMS-1500). Deben tener buenas habilidades escritas y comunicativas. Deben ser capaces de seguir directrices, realizar múltiples tareas y trabajar cómodamente dentro de un entorno orientado al equipo.