Insurance/Claims/Collections Supervisor, Medi-care/Medi-caid
4 weeks ago
Under the direct supervision of the PBS Collections Manager, this position is responsible for the day to day operations of the Collection Department to ensure they are in compliance with organizational and industry standards. Supervises the collection team staff activities that promote best practices for collection efficiency and maximization of revenue. Supervises daily activities of the hourly staff to ensure maximum collection of all receivable revenue and miscellaneous revenue. Identifies quality issues, advises management and implements solutions. Builds an effective team by demonstrating team leadership, budget development and management, work plan development and project implementation skills. Creates strong customer service orientation and collaboration, results orientation and strategic thinking within the Collections unit.
Essential Responsibilities:
Provides overall supervision of the collections department, contributes and ensures accurate and timely collection of all appropriate revenue for PBS. Recruits and maintains a competent, motivated and qualified staff including disciplining, counseling, coaching, advising, training, termination and resolution of personnel issues. Conducts performance evaluations for staff. Monitors and measures collection performance against cash performance targets by collector, by payer category, by medical center and division, and maintains communication between the collections teams and service area PBS teams. Identifies and develops new products and services to enhance recoveries. Communicates updated procedures and information to all involved parties. Ensures effective financial management of Accounts Receivable, to include financial tracking and analysis of financial recoveries and performance. Plans and implements departmental programs and systems that provide analytical support on financial issues. Authorizes refunds, write offs and adjustments up to a specified amount.
Provides consulting expertise to business function areas and coordinates/conducts required training as identified from various sources or externally mandated requirements; stays abreast of all regulatory changes and requirements; implements and communicates changes to department and service area staff within PBS. Ensures timely and accurate processing of industrial, TPL, COB, commercial insurance, Medi-Cal, and outpatient Medicare and self pay accounts in accordance with best practices, defined process flows and procedures and applicable legislative and regulations. Ensures consistent application of processing procedures, policies and personnel practices among the employees on the collection team and promotes organization and division strategic objectives. Supervises the work of the staff in maintaining high quality of work with revenue enhancement and customer service focus, through monitoring operational performance, and implementation and improvement options for either/or Northern and Southern California. Ensures consistent application of divisional wide operational practices, policies and procedures. Develops, recommends, implements and monitors goals, objectives, and performance standards Tracks and analyzes financial recoveries of outside vendors, ensuring effective performance. Plans, develops, and implements administrative strategies consistent with business plans, organizational goals, health plan member service agreements and federal and state law. Ensures appropriate financial reporting and accounting of revenue. Ensures preparation of Northern and/or Southern California general accounting documents for monthly revenue and PBS financial reports. Resolves policy issues and in cooperation with Marketing and Sales, Regional Claims, Membership Accounting, Accounts Receivable, Legal and Members Services as needed. Responsible for payroll and non-payroll budgets for North and/or South cost centers. Coordinates the resolution of complaints with appropriate division and facilities personnel. Respond to complex issues relating to members, patients, insurance companies, attorneys, KP employees, and, if appropriate, follow-up with written response. Hires, disciplines and counsels and conducts performance evaluations for hourly staff.
Basic Qualifications:
Experience
Minimum three (3) years experience leading, managing or supervising staff, preferably in a healthcare environment.
Education
Bachelors degree required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
Collection Management experience in a health care setting.
Familiarity with specific lines of business (e.g. billing, collections, governmental programs, etc).
Knowledge of applicable state and federal regulations related to billing and collections.
Knowledge in budgeting and accounting principles and of personnel/labor laws and regulations.
Knowledge of systems requirement development and user acceptance testing.
Excellent negotiating and analytical skills.
Demonstrated interpersonal skills in dealing with employees and all levels of management. User knowledge of word processing and spreadsheet software and mainframe systems.
Strong verbal and written communication skills and excellent presentation skills.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Knowledge and understanding of the relationship between management and union contracts and work within the parameters of the Labor management partnership, preferred.
#LI-DP1
We have other current jobs related to this field that you can find below
-
Pasadena, California, United States Kaiser Permanente Full timeJob Summary:Under the direct supervision of the PBS Collections Manager, this position is responsible for the day to day operations of the Collection Department to ensure they are in compliance with organizational and industry standards. Supervises the collection team staff activities that promote best practices for collection efficiency and maximization of...
-
Executive Director, Medi-Care Strategy
4 weeks ago
Pasadena, United States Kaiser Permanente Full timeJob Summary: This position enables regional leadership to develop, plan, drive and implement our Medi-Care strategy for SCAL in alignment with the organization-s mission strategic business plan and related performance expectations. Essential Responsibilities: + Provide leadership and strategic direction for Medicare and resource intensive members...
-
Ob/gyn Medical Biller/collector
2 weeks ago
Pasadena, United States Aaron J Epstein MD INC Full timeExperience in OB/GYN and/or Maternal Fetal Medicine+ Must have experience Medi-Cal, HMO. Functions include following up on claim status, collecting insurance and third-party receivables, and resolving insurance denials. Performs related duties as required. *Must have minimum of 2 years experience in billing and collections including Medi-Cal FFS billing. -...
-
Mis Data Specialist
4 weeks ago
Pasadena, United States D'Veal Family and Youth Services Full time**MIS Data Specialist Job Description** Join our non-profit 501(c)(3) corporation. We at D’Veal Family and Youth Services (D’Veal) understand it is vital that behavioral health challenges of children and families in the San Gabriel Valley and Los Angeles County be met with services consistent with the dynamic needs of today’s world, and within the...
-
Insurance Claims Specialist
3 weeks ago
Pasadena, United States ACCO Engineered Systems Full time**General Job Description**: **Supervises**: - **None** **Essential Duties & Responsibilities** - Gather data and File third party property damage claims, third party injury claims, automobile accident claims, property claims, and workers compensation claims with the carrier. - Attend all claims reviews, track action items and provide follow-up reports. -...
-
Insurance Claims Specialist
2 weeks ago
Pasadena, California, United States ACCO Engineered Systems Full timeWelcome to the Job Description of Claims Specialist We are on the lookout for a meticulous and well-organized Claims Specialist to join our dynamic team. As a Claims Specialist, you'll be pivotal in handling various insurance claims efficiently and accurately, ensuring compliance with company regulations and policies. We require someone with top-notch...
-
Insurance Claims Specialist
2 days ago
Pasadena, United States ACCO Engineered Systems Full timeGeneral Job Description: We are seeking a detail-oriented and organized Claims Specialist to join our team. The Claims Specialist will play a crucial role in managing various types of insurance claims, ensuring accuracy, efficiency, and compliance with company policies and regulations. The ideal candidate will possess strong analytical skills, exceptional...
-
Insurance Claims Specialist
4 weeks ago
Pasadena, United States ACCO Engineered Systems Full timeGeneral Job Description: We are seeking a detail-oriented and organized Claims Specialist to join our team. The Claims Specialist will play a crucial role in managing various types of insurance claims, ensuring accuracy, efficiency, and compliance with company policies and regulations. The ideal candidate will possess strong analytical skills, exceptional...
-
Insurance Claims Specialist
7 days ago
Pasadena, United States ACCO Engineered Systems Full timeGeneral Job Description: We are seeking a detail-oriented and organized Claims Specialist to join our team. The Claims Specialist will play a crucial role in managing various types of insurance claims, ensuring accuracy, efficiency, and compliance with company policies and regulations. The ideal candidate will possess strong analytical skills, exceptional...
-
Case Manager I
3 weeks ago
Pasadena, United States HealthRIGHT 360 Full timeJob Overview This is a union position.Pasadena Outpatient Behavioral Health Services provides comprehensive mental health services for our community ages birth through older age. Our continuum of care ranges from prevention and early intervention to intensive outpatient services for those with more serious and chronic conditions, including Full-Service...
-
Billing and Collections Associate
1 week ago
Pasadena, United States GrandCare Health Services Full timeJob DescriptionJob DescriptionGrandCare Health Services is a physician-trusted leader in post-surgical rehabilitation delivered in the comfort of patients’ own homes. We are recognized by the Centers for Medicare and Medicaid Services as a 5-Star agency, placing us in the top 10% nationally. Our experienced clinicians collaborate closely with patients’...
-
Billing and Collections Associate
4 weeks ago
Pasadena, United States GrandCare Health Services Full timeJob DescriptionJob DescriptionGrandCare Health Services is a physician-trusted leader in post-surgical rehabilitation delivered in the comfort of patients’ own homes. We are recognized by the Centers for Medicare and Medicaid Services as a 5-Star agency, placing us in the top 10% nationally. Our experienced clinicians collaborate closely with patients’...
-
Regional Director of Care Coordination in The
4 weeks ago
Pasadena, United States Kaiser Permanente Full time**Job Summary**: Responsible for providing strategic development/planning, oversight, implementation, coordination, and evaluation/improvement within the inpatient case management, post-acute case management, and /or affiliate hospital space. Supports the medical centers in the oversight, development, and implementation of seamless transitions across the...
-
Front Office Clerk-Pasadena
6 days ago
Pasadena, United States JWCH Institute Full timeJob DescriptionJob DescriptionPosition Purpose: The Front Office Clerk for JWCH-Pasadena Clinic is a full-time position under the direction of the Clinic Administrator. The Front Office Clerk is responsible for the financial screening of all clients for state certification of eligibility, reception area duties, responding to client questions, and providing...
-
Claims Team Lead
7 days ago
Pasadena, United States Sedgwick Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...
-
Collections Supervisor
1 week ago
Pasadena, United States ACCO Engineered Systems Full time**General Job Description**: The Collections Supervisor will oversee the collection and paperwork needed to collect on all JDE projects. Running a team of collectors to ensure collections is being done timely and efficiently. Also responsible for the Subcontractors credit box and ensuring they are paid as we are paid and that process. Also, all items related...
-
Contracting Specialist
4 weeks ago
Pasadena, United States Call the Car Full time**JOB OVERVIEW** Under the supervision of the Director of Provider Relations, the Contracting Specialist is responsible for researching & recruiting new subcontractors, the initial sub-contractor contracting process, and ensuring subcontractor compliance with contractual obligations. **TYPICAL WORKING CONDITIONS** The typical working condition for this...
-
Pasadena, CA, United States Kaiser Permanente Full timeJob Summary: Responsible for providing strategic development/planning, oversight, implementation, coordination, and evaluation/improvement within the inpatient case management, post-acute case management, and /or affiliate hospital space. Supports the medical centers in the oversight, development, and implementation of seamless transitions across the...
-
Case Manager I
4 weeks ago
Pasadena, United States HealthRIGHT 360 Full timeHealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment. Our Outpatient services specialize in treatment mental health and substance use disorders with treatment and skills groups,...
-
Team Supervisor
2 weeks ago
Pasadena, Texas, United States Pacific Clinics Full timeWho We ArePacific Clinics is California's largest community-based nonprofit provider of behavioral and mental health services and support. Our team of more than 2,000 employees speak 22 languages and are dedicated to offering hope and unlocking the full potential of individuals and families through culturally responsive, trauma-informed, research-based...
