Supervisor, Claims Operations

AltaMed Health Services Corp; Montebello (CA); On-site; USD 74,000 - 93,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

FSA

Commuter Benefits

Career Development

Paid Time Off

CME Days

Malpractice Tail Coverage

Tuition Reimbursement

Employee Discounts

Referral Bonus

Pet Insurance

Job summary

AltaMed Health Services Corp in California is seeking a Claims Operations Supervisor to oversee both external and internal claims adjudication processes. You will compile and scrub data to analyze trends, monitor TAT, production, and error rates, and generate forecasting and monthly health plan reports.

You will identify root causes of payment errors and partner with other departments and providers to resolve issues, ensuring accurate, timely claims handling across the organization.

Qualifications

• Associates degree (AA/AS) or Bachelor’s degree is highly recommended.
• Must be knowledgeable of Medi-Cal regulations, Commercial, and Medicare rules and regulations and medical terminology.
• HS Diploma required.
• Minimum of 5 years of experience in a managed care environment, claims knowledge preferred.
• Must have an understanding to read CMS-1500 and UB-04 forms and be able to read and interpret DOFRs and Contracts.
• Must have strong organizational and mathematical skills.

Responsibilities

• Oversee external and internal processes related to Claims Adjudication.
• Compile and scrub claims data to analyze, track, and trend adjudicated claims.
• Monitor TAT, production, error rate, mid-month forecasting reports, and health plan reporting.
• Identify root causes of payment errors and report to management.
• Collaborate with other departments and providers to resolve claims issues.

Skills

Medi-Cal regulations knowledge

Commercial and Medicare rules

Medical terminology

Strong organizational skills

Strong mathematical skills

Education

Associates or Bachelor’s degree

Job description

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed.

At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day.

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 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

• Associates degree (AA/AS) or Bachelor’s degree is highly recommended.
• Must be knowledgeable of Medi-Cal regulations, Commercial, and Medicare rules and regulations and medical terminology.
• HS Diploma required.
• Minimum of 5 years of experience in a managed care environment, claims knowledge preferred.
• Must have an understanding to read CMS-1500 and UB-04 forms and be able to read and interpret DOFRs and Contracts.
• Must have strong organizational and mathematical skills.

Compensation

$74,144.18 - $92,680.22 annually

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations, and The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

Job Advertisement & Application Compliance Statement

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

As the nation’s largest Federally Qualified Health Center (FQHC), AltaMed is at the forefront of providing affordable, high-quality health care to underserved communities in Los Angeles and Orange Counties. At AltaMed, you will have the opportunity to work with a diverse team of dedicated professionals who are passionate about making a difference and supporting our community of over 400,000 patients.

Learn About AltaMed: Click Here

AltaMed Health Services Corporation is committed to providing equal employment opportunities for all qualified individuals. We strictly prohibit discrimination in employment based on race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin, age, medical condition, physical or mental disability, military or protected veteran status, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical conditions, genetic information, or any other characteristic protected by local, state, or federal law, ordinance, or regulation. We are committed to promoting equality and inclusivity beyond our recruitment and hiring processes. We aim to create a respectful, valued, and inclusive workplace through training, advancement opportunities, and access to resources and support. We focus on fostering a diverse workforce because it enriches our organization and improves our ability to effectively serve our clients and community. We encourage individuals from all backgrounds to apply and join us in our mission to create a positive impact.