Claims Processing Supervisor
APR Consulting, Inc. has been engaged to identify a Claims Processing Supervisor
Location: Pasadena, Ca 91103
Position: Claims Processing Supervisor
Pay Rate: $31 – 34/hr DOE
Duration: 7 months
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
Our client is one of the largest non-profit health plan founded in 1945 which offers comprehensive, affordable health coverage plans for individual & family, Medicare, employers, and large group.
- Under the direct supervision of the PBS Collections Manager, this position is responsible for the day to day operations of the Collection Department to ensure they are in compliance with organizational and industry standards.
- Supervises the collection team staff activities that promote best practices for collection efficiency and maximization of revenue.
- Supervises daily activities of the hourly staff to ensure maximum collection of all receivable revenue and miscellaneous revenue. Identifies quality issues, advises management and implements solutions.
- Builds an effective team by demonstrating team leadership, budget development and management, work plan development and project implementation skills. Creates strong customer service orientation and collaboration, results orientation and strategic thinking within the Collections unit.
MAJOR RESPONSIBILITIES/ESSENTIAL FUNCTIONS
The primary job duties this position is responsible for achieving are listed in order of importance.
- Provides overall supervision of the collections department, contributes and ensures accurate and timely collection of all appropriate revenue for PBS.
- Recruits and maintains a competent, motivated and qualified staff including disciplining, counseling, coaching, advising, training, termination and resolution of personnel issues. Conducts performance evaluations for staff.
- Monitors and measures collection performance against cash performance targets by collector, by payer category, by medical center and division, and maintains communication between the collections teams and service area PBS teams.
- Identifies and develops new products and services to enhance recoveries.
- Communicates updated procedures and information to all involved parties.
- Ensures effective financial management of Accounts Receivable, to include financial tracking and analysis of financial recoveries and performance.
- Plans and implements departmental programs and systems that provide analytical support on financial issues.
- Authorizes refunds, write offs and adjustments up to a specified amount.
- Provides consulting expertise to business function areas and coordinates/conducts required training as identified from various sources or externally mandated requirements; stays abreast of all regulatory changes and requirements; implements and communicates changes to department and service area staff within PBS.
- Ensures timely and accurate processing of industrial, TPL, COB, commercial insurance, Medi-Cal, and outpatient Medicare and self-pay accounts in accordance with best practices, defined process flows and procedures and applicable legislative and regulations.
- Ensures consistent application of processing procedures, policies and personnel practices among the employees on the collection team and promotes organization and division strategic objectives.
- Supervises the work of the staff in maintaining high quality of work with revenue enhancement and customer service focus, through monitoring operational performance, and implementation and improvement options for either/or Northern and Southern California.
- Ensures consistent application of divisional wide operational practices, policies and procedures.
- Develops, recommends, implements and monitors goals, objectives, and performance standards
- Tracks and analyzes financial recoveries of outside vendors, ensuring effective performance.
- Plans, develops, and implements administrative strategies consistent with business plans, organizational goals, health plan member service agreements and federal and state law.
- Ensures appropriate financial reporting and accounting of revenue.
- Resolves policy issues and in cooperation with Marketing and Sales, Regional Claims, Membership Accounting, Accounts Receivable, Legal and Members Services as needed.
- Responsible for payroll and non-payroll budgets for North and/or South cost centers.
Compensation & Benefits
At a minimum, a 7-year background check, education verification, employment verification, and drug screen will be conducted upon hire. Your suitability for employment is contingent upon successfully passing these required pre-employment screenings.
Don't miss out on this amazing opportunity! If you feel your experience is the match for this position please apply today and join our team. We look forward to working with you!
Equal Opportunity Statement:
“APR Consulting, Inc. is an equal opportunity employer and will consider all applications for all positions equally without regard to race, sex, age, color, religion, national origin, veteran status or any disability as provided in the Americans with Disabilities Act. APR Consulting, Inc. participates in E-Verify. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States.”E-Verify Statement:
APR participates in the E-Verify Employment Eligibility Program.