The Supervisor, Claims Audit reports to the Manager, Claims Audit and responsible for the daily operations of the Claims Auditing Department. This position will assist in managing, overseeing, and fulfilling requirements for all internal claims audits and adjudications for all product lines (Medicare, Commercial, and Medi-Cal) for all health plans to maintain timeliness and accuracy in accordance to policies and procedures, contractual obligations, and all regulatory requirements. The position will provide timely reporting on Auditing issues that impact progress and provide conflict resolution, as needed. This includes documenting, prioritizing, and tracking claims, operational audits, and managing resources to meet critical time frames. This position will work collaboratively with staff and management team to achieve overall departmental efficiency, accuracy, and regulatory compliance. In addition, this position is responsible for assisting in recruitment, hiring, training, development and retention of staff.
Associate's Degree or equivalent education/experience
If position requires driving, a valid driver’s license and proof of insurance per company policy upon hire
2 years Supervisory/management experience in an ambulatory or acute care setting
3 years experience processing and adjudicating all types of claims in Managed Care environment
3 years experience auditing professional and institutional claims
Bachelor’s Degree in Health Care Administration
5 years experience in Claims Audit
2 years claims audit or quality assurance experience
3 years experience in a healthcare organization working with health plan or government regulations
3 years Supervisory/management experience in an ambulatory or acute care setting
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
About the Team
Providence Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.
PE is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington’s greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence’s St. John’s Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.
We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.
We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.
Requsition ID: 106674
Company: Providence Jobs
Job Category: Claims
Job Function: Revenue Cycle
Schedule: Full time
Career Track: Leadership
Department: 7520 CLAIMS AUDITING CA HERITAGE SERVICES
Address: CA Anaheim 200 W Center St Promenade
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.