Apply on Employer Site

Partnership HealthPlan of California · 2 days ago

Claims Audit Supervisor

Fairfield, CA

Full-time

Onsite

Mid, Senior Level

$94K/yr - $117K/yr

3+ years exp

Partnership HealthPlan of California is seeking a Claims Audit Supervisor to oversee claims auditors and fraud, waste, and abuse coordinators. The role involves ensuring compliance, supervising audit workflows, and maintaining high levels of customer service while developing training programs for staff.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Supervises claims auditors and their job functions

Supervises the audit workflow

Supports claims audit functions

Maintains audit inventories within established goals

Supervises Claims Fraud, Waste, and Abuse Coordinators and their job functions

Works closely with Partnership Compliance Department

Reviews quality control audits to ensure compliance within established department guidelines and policies and procedures

Identifies errors and deficiencies, develops and implements corrective action and training plans for audit staff

Interviews and participates in the selection of qualified candidates for the claims audit positions

Trains new staff

Evaluates performance and provides developmental opportunities for staff

Counsels performance problems or issues when needed

Reviews and signs time sheets

Drafts important provider notices for Senior Claims Director’s review

Participates in the review of Claims Operating Memorandums, recommends changes for more efficient operations, communicates changes and updates to auditing staff when appropriate

Ensures that concurrent, retrospective, and special audits are completed accurately and timely

Reports outcomes to Claims Department Supervisors, Managers, Associate Directors, and Directors

Develops and implements training schedules for new Claims Examining and CSR staff with Claims Supervisors

Develops and updates Claims Examining and CSR training materials

Supervises and participates in Partnership delegated entity audits

Collects, monitors, tracks, and reports claims delegation reporting for capitated entities to the Partnership sub delegation committee

Attends Partnership sub delegation committee meetings

Other duties as assigned

Qualification

Claims auditingCPT codingICD-9 codingHCPC codingMedical terminologyAutomated claims proceduresTyping speed 30 wpm10-key calculator proficiencyOral communicationWritten communicationInterpersonal skillsOrganizational skills

Required

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

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 of 30 wpm and proficient use of 10-key calculator preferred

Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business

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

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 size, weighing up to 10 lbs

Preferred

Bachelor's degree in related field preferred

Minimum three (3) years of supervisor experience in a claims environment preferred

Prior Medi-Cal claims and audit experience preferred

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

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