Work Boldly. Live Brilliantly.
At AltaMed, we don’t just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It’s the calling of our lives and it compels us to keep moving forward.
Job Overview
The Claims Operations Supervisor is responsible for the oversight of external as well as internal processes as it relates to Claims Adjudication. This includes the compilation and scrubbing of claims data in order to analyze, track, and trend various aspects of the adjudicated claims. This includes but is not limited to, TAT compliance, Production, Error Rate, mid-month reports for forecasting, Health Plan monthly reporting including ODAG and Part C, Health Plan Universes for Audits, reports to identify potential recovery, as well as reports requested by various personnel at AltaMed. The Claims Operations Supervisor will identify root causes of claims payment errors and reports to management as well as collaborates with other departments and/or providers in successful resolution of claims related issues.
Minimum Requirements
1. HS Diploma required.
2. AA/AS or Bachelor’s degree is highly recommended.
3. Minimum of 5 years of experience in a managed care environment, claims knowledge preferred.
4. Minimum of 1 year of SQL coding and programming experience.
5. Must be knowledgeable of Medi-Cal regulations, Commercial, and Medicare rules and regulations and medical terminology.
6. Must have an understanding to read CMS-1500 and UB-04 forms and be able to read and interpret DOFRs and Contracts.
7. Must have strong organizational and mathematical skills.
Benefits & Career Development
Claims Supervisor • Montebello, California, CA, US
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