The Claims Supervisor directly supervises claims examiners and carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsible for a higher-level knowledge in the analysis and management of professional, outpatient and inpatient facility claims
Job Duties and Responsibilities:
Responsible for supervising the overall quality of claims processes as they pertain to departmental policies and procedures as well as compliance, in accordance with CMS, DMHC, and Health Plan and contractual obligations
Responsible for coordinating subordinate employee recruitment, performance assessment, work assignments, salary, and recognition/disciplinary actions
Provide training support for new employees and existing Claims Examiners.
Distributes work through review of inventory and pended claim reports
Provide claims support to teams in reviewing, resolving, member and provider appeals and disputes
Responsible to process and respond to Health Plan inquiries and coordinates with appropriate departments for any provider, member, or system issues
Responsible for recommending changes in guidelines, procedures, and policies. Ensuring the use of standard methodology workflows and operational excellence in activities are utilized
Advise the training of team members on workflow and contractual modifications expeditiously
High school diploma or GED required.
Two (2) years of supervisory experience.
Five (5) years of experience in any of the following combined: claims auditing, professional and facility claims processing for Medicare and Commercial products, provider dispute resolution processing in an IPA, HMO and Hospital related setting.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.