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Claims Supervisor California

Company: Health Source MSO
Location: Pasadena
Posted on: September 16, 2023

Job Description:

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-9, 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


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 position

Medical Insurance
Dental Insurance
Vision Insurance
Paid Time Off
401K Matching

Keywords: Health Source MSO, Pasadena , Claims Supervisor California, Other , Pasadena, California

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