Supervisor, Claims Operations

AltaMed; Montebello (CA); In loco; USD 74.000 - 93.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, Dental and Vision insurance

403(b) Retirement savings with company

Flexible Spending Accounts

Paid Time Off & Holidays

Tuition Reimbursement

Descrizione del lavoro

AltaMed in Montebello, CA is seeking a Claims Operations Supervisor to oversee internal and external claims adjudication processes. You will compile and scrub data, track TAT, production, and error rates, and generate mid-month and health plan reports to support forecasting and audits.

The role requires reading CMS-1500 and UB-04, knowledge of Medi‑Cal, Medicare and commercial rules, plus 5+ years in a managed care environment.

Competenze

• AA/AS or Bachelor's degree recommended
• Must understand Medi-Cal, Commercial, and Medicare rules
• HS Diploma required
• Minimum 5 years in a managed care environment
• Ability to read CMS-1500 and UB-04 forms and interpret DOFRs/Contracts
• Strong organizational and mathematical skills

Mansioni

• Oversee internal and external claims adjudication processes
• Compile and scrub claims data to analyze and forecast performance
• Produce mid-month forecasts and health plan reports for audits and reviews
• Identify root causes of payment errors and collaborate with other departments for resolution

Conoscenze

Organizational skills

Analytical skills

CMS-1500 & UB-04 reading

Attention to detail

Formazione

Associate or higher degree

HS Diploma required

Descrizione del lavoro

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. 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.