What are the responsibilities and job description for the Claims Encounter and System Process Improvement Supervisor position at Kern Family Health Care?
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
KHS reasonably expects to pay starting compensation for the position of Claims Encounter and System Process Improvement Supervisor in the range of $83,625 -106,622 annual.
"Onsite Position"
About Us
Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
About The Role
Under management direction, this position is responsible for overseeing all aspects of the Claims Encounter process and Claims System processes and improvements. This includes supervising Claims Encounter and System Testing staff to ensure the accuracy, compliance, and timely submission of encounter data to the state, as well as ensuring the accuracy of claims payments and optimization of auto-adjudication processes.
The role is accountable for maintaining regulatory compliance in encounter submissions and identifying, developing, and implementing process improvements for a Knox-Keene licensed Health Maintenance Organization (HMO), covering both Medi-Cal and Medicare lines of business.
Essential Duties And Responsibilities
Bachelor's degree in business administration or related field AND 6 years of administrative or supervisory experience in a medical claims’ payment processing operation. 2 of 6 years must be supervisory or lead or senior level Claims payment processing position or configuration.
OR
8 years of experience in healthcare with emphasis on coding, financial rate set up or claims processing in a managed care environment. 2 of 8 years must be supervisory or lead or senior level Claims department function, encounter submissions or configuration.
Health maintenance organization (HMO) claims payment-processing experience is highly desirable.
State/Federal Encounter Submission experience is highly desirable.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.
KHS reasonably expects to pay starting compensation for the position of Claims Encounter and System Process Improvement Supervisor in the range of $83,625 -106,622 annual.
"Onsite Position"
About Us
Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
About The Role
Under management direction, this position is responsible for overseeing all aspects of the Claims Encounter process and Claims System processes and improvements. This includes supervising Claims Encounter and System Testing staff to ensure the accuracy, compliance, and timely submission of encounter data to the state, as well as ensuring the accuracy of claims payments and optimization of auto-adjudication processes.
The role is accountable for maintaining regulatory compliance in encounter submissions and identifying, developing, and implementing process improvements for a Knox-Keene licensed Health Maintenance Organization (HMO), covering both Medi-Cal and Medicare lines of business.
Essential Duties And Responsibilities
- Leads, trains, develops and evaluates assigned staff. Apply personnel policies and ensure the continual development of staff.
- Manage team production, workloads, and priorities to ensure adherence to established performance standards and timely delivery of objectives.
- Conduct audits of encounter submissions, claims core processing systems, and claims editing software to improve operational efficiency, enhance auto-adjudication, ensure accurate provider payments, and maintain regulatory compliance.
- Oversee encounter submission workflows through MDS and other applicable systems to ensure timely and accurate reporting to the state.
- Research and resolve encounter and provider payment errors; provide guidance to staff on new error handling procedures.
- Develop encounter data reports and analyze denial trends to identify discrepancies, billing errors, and opportunities for process improvement.
- Implement preventative measures based on analysis of encounter denial and adjudication data.
- Collaborate with EDI Analysts, EDI Programmers, and Senior Claims staff to implement encounter data updates, system enhancements, and configuration changes.
- Assist in defining test case scenarios and oversee application and configuration testing, including new contracts, system modifications, and upgrades.
- Review proof of concepts and testing results to ensure accurate system investigation, evaluation, and design validation.
- Participate in internal and external meetings regarding claims-related system configuration and regulatory requirements; represent the department in monthly encounter calls.
- Communicate system issues, regulatory updates, and operational concerns to leadership (Director, Deputy Director, and Manager) and provide monthly performance and operational reports.
- Utilize claims adjudication and technology expertise to develop innovative business solutions that improve payment accuracy and examiner performance.
- Complete monthly performance reviews and annual appraisals for assigned staff.
- Perform other job-related duties as assigned and adhere to all company policies and procedures.
- Perform other duties as assigned.
Bachelor's degree in business administration or related field AND 6 years of administrative or supervisory experience in a medical claims’ payment processing operation. 2 of 6 years must be supervisory or lead or senior level Claims payment processing position or configuration.
OR
8 years of experience in healthcare with emphasis on coding, financial rate set up or claims processing in a managed care environment. 2 of 8 years must be supervisory or lead or senior level Claims department function, encounter submissions or configuration.
Health maintenance organization (HMO) claims payment-processing experience is highly desirable.
State/Federal Encounter Submission experience is highly desirable.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.
Salary : $83,625 - $106,622