Supervisor, Claims Compliance

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Job Overview

The Inbound Claims Operations Supervisor is responsible for oversight of staff and processes around the handling of claims and claim data before the information is loaded in the claims adjudication system, EZ-Cap. This includes claims received electronically (EDI) and claims received through the US Post Office. All US Mail is received through the Mailroom and by extension; the Inbound Claims Operations Supervisor provides oversight of the mailroom operations. Oversight of mailroom operations include the daily generation of letters required for regulatory compliance. The Inbound Claims Supervisor plans, organizes, and supervises/leads work of the assigned team, delegates tasks and communicates priorities, participates in the selection and evaluation of staff, evaluates outcomes and determines the most effective use of resources. Develops, reviews, revises, and enforces departmental policies, procedures, and processes.   

Minimum Requirements

• High school diploma or equivalent required.    

• Bachelor’s degree preferred.  

• Minimum of 4+ years of experience working with claims in a managed care environment. 

• Minimum of 2+ years of experience loading claims to a claims processing system. 

• Minimum of 2+ years of experience working with EDI Clearinghouses and EDI files.  

• Minimum of 1+ years of experience working with EZ-Cap software and EZ-Net software. 

• Minimum of 1+ years working with EDI translation software, preferably HipaaSuite. 

• Proficiency in Healthcare and Health Plan terminology, medical coding (e.g., CPT, HCPCS, ICD10, Revenue, DRG and other relevant medical and industry-standard codes). 

• Knowledge of print and mail automation software including but not limited to: Quadient Automated Insertion Management System, (AIMS) and Quadient Output Management System, (OMS) a plus. 

Compensation

$72,308.94 - $90,386.17 annually

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaM