Kaiser Permanente Supervisor Claims Processing in Oakland, California
Responsible for the operations of one or more claims processing units, including timely and proper adjudication of claims in accordance with contractual benefits. Responsible for providing leadership and direction to employees. Directs the processing of insurance claims to meet operational,financial, and service requirements. Develops and executes strategic and operational business plans for the departments. Coordinates department operations and modifications with other areas of the organization.
Essential Responsibilities: - Supervision of one or more claims processing units ensuring including timely and proper adjudication of claims in accordance with contractual benefits. - Responsible for providing leadership and direction to employees. - Directs the processing of insurance claims to meet operation, financial, and service requirements. - Develops and executes strategic and operational business plans for the departments. - Coordinates department operations and modifications with other areas of the organization. - Directs claims processing staff on a day-to-day basis, conducts performance evaluations and progressive discipline. - Acts as content and process subject matter expert, providing first line response to questions and training. - Analyzes and evaluates each outside medical services bill for appropriateness of charges and processes for payment ensuring payment is made only for authorized services, procedure codes are consistent with diagnosis codes and services are not unbundled. - Investigates and resolves billing problems. - Interprets existing contract language and responds to inquiries from outside providers regarding contractual arrangements. - Monitors billing practices of outside providers. - Reviews and processes Authorization for Medical Care which involves verifying eligibility, monitoring benefit limits, directing care to preferred providers and assigning reason and service codes. - Utilizes multiple mainframe systems to determine primary payer status of pending referrals and answers inquiries of patients and providers. - Works closely with KFHP case managers to inform them of all members in non-Kaiser hospitals to expedite repatriation and patients and providers to answer inquiries.
Supervise approximately 10-15 AP Local 29 employees demonstrating ability to plan, schedule, and direct day-to-day activities. The supervisor reports to the Accounts Payable Manager within the Financial Administration. The Supervisor is responsible to ensure department operations meet processing targets, rigorous quality standards, and comply with the Kaiser Permanente Group policies and procedures, generally accepted accounting principles and regulatory requirements. Utilize quality metrics and best practices to help drive and communicate business decisions. Provide and maintain superior customer service that will ensure continual process improvement. Works on problems/projects where analysis requires an in-depth evaluation of various factors.
Qualifications: Basic Qualifications: Experience - Minimum three (3) years of claims experience Education - Bachelor's degree in business administration, OR four (4) years of experience in a directly related field. - High School Diploma or General Education Development (GED) required. License, Certification, Registration - N/A
Additional Requirements: - Knowledge of medical terminology and application of medical billing codes required. - Excellent customer service, telephone presentation and problem solving skills. - Ability to prioritize work in a high volume demanding environment. - Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications: - Previous supervisory experience. - Previous experience working with a mainframe database system. - Extensive knowledge of medical billing standards, Medicare billing requirements and KFHP benefits preferred.
COMPANY Kaiser PermanenteTITLE Supervisor Claims ProcessingLOCATION Oakland, CAREQNUMBER 607394
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.