To supervise the Medi-Cal Claims Specialists and Examiners.
Ensures delivery of highest level of customer service to the
community and its medical providers.
+ 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
+ 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.
Education and Experience
Bachelor's degree in related field preferred; minimum three (3)
years supervisor experience in a claims environment; or equivalent
combination of education and experience; prior Medi-Cal claims
Special Skills, Licenses and Certifications
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 30 wpm and proficient use of 10-key calculator preferred.
Valid California driver's license and proof of current automobile
insurance compliant with PHC policy are required to operate a
vehicle and travel for company business.
Performance Based Competencies
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
Work Environment And Physical Demands
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 sizes, weighing up to 10 lbs.
All HealthPlan employees are expected to:
+ Provide the highest possible level of service to clients;
+ Promote teamwork and cooperative effort among employees;
+ Maintain safe practices; and
+ Abide by the HealthPlan's policies and procedures, as they may
from time to time be updated.
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions,
experience, educational factors and the requirements and conditions
listed in this job description are representative only and not
exhaustive or definitive of the tasks that an employee may be
required to perform. The employer reserves the right to revise this
job description at any time and to require employees to perform
other tasks as circumstances or conditions of its business,
competitive considerations, or work environment change.
External Company Name: Partnership HealthPlan of California
External Company URL: http://www.partnershiphp.org
Street: 4665 Business Center Drive
FLSA Status: Exempt