Manager, Claims Integrity Provider Remediation
4 weeks ago
Salary Range: $102, Min.) - $132, Mid.) - $156, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Manager, Claims Integrity Provider Remediation is responsible for development and implementation of methods to accurately and timely review provider escalations, inquiries, logs or other submissions. This position will work to best coordinate efforts across the Claims Integrity departments ensuring the highest level of quality responses to all stakeholders. This position will manage a team dedicated to maintaining constant communication, consistent quality, and root cause identification and resolution for provider cases. This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.
DutiesManages provider escalations, inquiries, logs or additional submissions to accurately and timely respond to all stakeholders. Monitors inventory to ensure prompt resolution while maintaining all regulatory requirements and timely escalation of areas close to non-compliance. Oversees preparation of summaries and reports for related tasks for both internal and external teams.
Oversees team in day to day operations to include timely and accurate response on all Provider Inquiries while assisting with resolution of higher complex cases. Meets with team regularly to detail project assignments, ensure accountability, review quality and work metrics. Manages team development and direct support to include training, performance standards, and process improvements.
Provides subject matter expertise, meets with Director and other Management to collaborate on provider meetings, ensuring all communications are clear, concise and accurate. Applies Medi-Cal and/or Medicare policies and procedures within healthcare operations. Stays abreast of all regulatory and/or contractual changes and the impact of these changes to provider escalated issues.
Supports the Director and other Management with development of department policies and procedures, workflows, training documents, etc. Consults with Claims Integrity team in making recommendations to management on operational issues.
Fosters and maintains a great place to work by communicating clear roles and responsibilities and building successful working relationships across Claims Integrity.
Manages staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
Performs other duties as assigned.
Duties ContinuedEducation Required
Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred
Experience
Required:
At least 5-7 years of experience related to Claims, Appeals and grievances, disputes, etc.
At least 3-4 years of supervisory/Management experience.
Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
Preferred:
Provider Dispute Resolution experience.
Required:
Extensive knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.
Strong project leadership and management skills required; ability to prioritize, plan, and handle multiple tasks/demands simultaneously; strong attention to detail.
Knowledge of Microsoft Office suite, including Word, Excel and PowerPoint.
Excellent interpersonal, verbal, and written communication skills.
Must be highly collaborative and maintain a consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas.
Must be able to present findings to various levels of management, and including stakeholders, across all organization.
Preferred:
Ability to review claims in 360-degree approach.
Licenses/Certifications Preferred
Certified Professional Coder (CPC) or other equivalent Coding CertificationRequired Training
Physical Requirements
LightAdditional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
-
Manager, Claims Integrity Provider Remediation
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $102, Min.) - $132, Mid.) - $156, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Manager, Claims
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $102, Min.) - $132, Mid.) - $163, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Payment Integrity Recovery Services Processor II
1 month ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $50, Min.) - $62, Mid.) - $75, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Examiner II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $55, Min.) - $69, Mid.) - $75, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Data Entry Clerk II
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure...
-
Claims Data Entry Clerk II
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Data Entry Clerk II
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Compliance Data Validation Analyst II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Compliance Data Validation Analyst II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Integrated Brand Marketing Manager
2 days ago
Los Angeles, California, United States Buck Mason Full timeBuck Mason is seeking a Sr. Integrated Marketing Director - a strategic and creative marketing leader with taste for days. You're a true marketer, obsessed with telling our brand and product stories across all channels and every medium. You have the chops to create a global calendar and manage an entire team to cohesively execute one vision. The right...
-
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Provider Data Quality Auditor II
1 month ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $55, Min.) - $69, Mid.) - $82, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Financial Compliance Data Manager II
1 month ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $102, Min.) - $132, Mid.) - $163, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Data Governance Program Manager I
3 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $105, Min.) - $122, Mid.) - $139, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Data Governance Program Manager I
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $105, Min.) - $122, Mid.) - $139, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Vulnerability Program Manager III
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $121, Min.) - $160, Mid.) - $180, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Claims Documentation Specialist II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Senior Integrated Producer
1 month ago
Los Angeles, California, United States Watson Design Group, Inc Full timeWatson is looking for an experienced Senior Integrated Producer with an entertainment background.Please note our account managers are hybrid producers - so production experience is crucial.)This position will be responsible for running and managing a retainer that involves a major motion picture studio.You are intuitive when it comes to client management and...
-
Enterprise Shared Services Program Manager II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five...
-
Vulnerability Program Manager III
2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $121, Min.) - $160, Mid.) - $180, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
