Claims Supervisor - CommonSpirit Health

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Assist Claims Manager in day to day supervision, support and monitoring of the Claims Examination team acting as the Claims department subject matter expert. Provide analysis of daily claims compliance reports and prioritize or re-prioritize the work in progress based on findings. This position reports to the Claims Manager. This position has supervisory responsibility over several Claims Examiners.

Minimum Qualifications:

• Five or more years experience performing Claims Examination in a healthcare or managed care environment. Two or more years of supervisory experience in a business office or healthcare environment.
• High School Diploma or equivalent required
• Current CA Drivers License and clean DMV required.
• Proficient in the use of Microsoft Office applications; Excel, Word, Access, Outlook, PowerPoint, Project, etc. Proficient in the use of QNXT to troubleshoot claims issues. Strong knowledge of CPT and ICD9/ICD10 coding. Knowledge of Medicare payment systems. Ability to make priority decisions based on staffing levels, claims volumes, and report analysis to meet the needs of internal and external customers throughout the workday. Ability to interpret and communicate complex contract or benefit language. Ability to effectively provide feedback to Examination team members through written and verbal communication. Ability to troubleshoot claims issues and provide resolution or make recommendations to correct. Strong problem-solving abilities. Ability to identify issues and problems within operations, program systems, administrative activities, and other relevant areas. Must be able to work collaboratively with multiple internal departments as well as external organizations. Thorough knowledge of generally accepted professional office procedures and processes.