Alameda Alliance for Health
Supervisor, D-SNP Claims Processing / 788851527
Alameda Alliance for Health - Alameda, California, United States, 94501
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Supervisor, D-SNP Claims Processing / 788851527
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Supervisor, D-SNP Claims Processing / 788851527
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Alameda Alliance for Health Principal Responsibilities
Under the general direction of the Manager, Claims Production, the Dual Eligible Special Needs Plan (D-SNP) Claims Processing Supervisor is responsible for supervising Claims staff processing D-SNP claims, collaborating with other departments to meet performance targets. The Supervisor provides direct supervision to Claims Processors and may assist in supervising other staff levels as workload permits. The Supervisor ensures claims are processed accurately and timely, complies with Medicare and Medi-Cal regulations, oversees workflow systems, monitors standards, and collaborates across departments to meet organizational goals. Additional Responsibilities
Develop and monitor production goals, assign workloads, and oversee reporting. Respond to provider inquiries and advise other departments on claims issues. Manage staff attendance, performance reviews, training, and development. Prepare for audits and participate in meetings and committees. Essential Functions
Ensure accurate, timely processing of D-SNP claims per regulations. Lead claims staff, develop standards, and identify process improvements. Analyze complex claim issues, generate reports, and communicate effectively. Develop and maintain claims procedures and respond to inquiries. Physical Requirements
Constant visual work, sitting, data entry, and communication. Frequent lifting, walking, and standing. Supervision
Number of Employees Supervised: 5-10 Minimum Qualifications
Bachelor’s degree or equivalent experience; High School Diploma or GED required. Seven years in medical claims processing, with three+ years in D-SNP or Medicare Advantage, and three+ years with Medi-Cal claims. Two years in supervisory or related roles preferred. Skills and Abilities
Strong knowledge of Medicare, CPT, HCPCS, ICD-10, and related coding and policies. Experience with HIPAA, EDI, and claims processing systems. Leadership, organizational, communication, and problem-solving skills. Proficiency in Windows, Microsoft Office, and claims software; RAM HealthSuite experience a plus. Salary Range
$83,241.60 - $124,862.40 annually
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Supervisor, D-SNP Claims Processing / 788851527
role at
Alameda Alliance for Health 1 week ago Be among the first 25 applicants Join to apply for the
Supervisor, D-SNP Claims Processing / 788851527
role at
Alameda Alliance for Health Principal Responsibilities
Under the general direction of the Manager, Claims Production, the Dual Eligible Special Needs Plan (D-SNP) Claims Processing Supervisor is responsible for supervising Claims staff processing D-SNP claims, collaborating with other departments to meet performance targets. The Supervisor provides direct supervision to Claims Processors and may assist in supervising other staff levels as workload permits. The Supervisor ensures claims are processed accurately and timely, complies with Medicare and Medi-Cal regulations, oversees workflow systems, monitors standards, and collaborates across departments to meet organizational goals. Additional Responsibilities
Develop and monitor production goals, assign workloads, and oversee reporting. Respond to provider inquiries and advise other departments on claims issues. Manage staff attendance, performance reviews, training, and development. Prepare for audits and participate in meetings and committees. Essential Functions
Ensure accurate, timely processing of D-SNP claims per regulations. Lead claims staff, develop standards, and identify process improvements. Analyze complex claim issues, generate reports, and communicate effectively. Develop and maintain claims procedures and respond to inquiries. Physical Requirements
Constant visual work, sitting, data entry, and communication. Frequent lifting, walking, and standing. Supervision
Number of Employees Supervised: 5-10 Minimum Qualifications
Bachelor’s degree or equivalent experience; High School Diploma or GED required. Seven years in medical claims processing, with three+ years in D-SNP or Medicare Advantage, and three+ years with Medi-Cal claims. Two years in supervisory or related roles preferred. Skills and Abilities
Strong knowledge of Medicare, CPT, HCPCS, ICD-10, and related coding and policies. Experience with HIPAA, EDI, and claims processing systems. Leadership, organizational, communication, and problem-solving skills. Proficiency in Windows, Microsoft Office, and claims software; RAM HealthSuite experience a plus. Salary Range
$83,241.60 - $124,862.40 annually
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