Apply on Employer Site

Partnership HealthPlan of California · 1 week ago

Claims Medi-Cal Supervisor

Sonoma County, CA

Full-time

Onsite

Mid, Senior Level

$45.04/hr - $56.30/hr

3+ years exp

Partnership HealthPlan of California is seeking a Claims Medi-Cal Supervisor to oversee the Medi-Cal Claims Specialists and Examiners, ensuring high levels of customer service. The role involves supervising claims workflow, training staff, and maintaining compliance with department guidelines.

Health CareInsuranceNon Profit

Culture & Values

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

Qualification

Medi-Cal claims experienceCPT codingICD-9 codingAutomated claims proceduresMedical terminologyTyping speed 30 wpm10-key calculator proficiencyCommunication skillsInterpersonal skillsOrganization skills

Required

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

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

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

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

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

Preferred

Bachelor's degree in related field

Prior Medi-Cal claims experience

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

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