Supervisor, Claims (CQI) Needed!

Position Responsibilities

• Train, audit and supervise all QA staff to ensure adherence to the Medi-Cal and Medicare processing guidelines. Identify any new learning opportunities for staff (i.e. new desktops).

• Monitor staff to ensure department turn-around times for claims auditing are met. Ninety five percent (95% of all claims must be paid or denied within 30 calendar days and 100% within 60 days from date of receipt to date of financial run.

• Must serve as a back up to claims processing when needed to ensure the department turn-around times are met and maintain inventory within 21 days on hand.

• Responsible for prompt communication with staff. Must schedule monthly unit meetings to go over any changes to programs or training issues; schedule monthly one-on-one meetings with staff to go over their monthly progress regarding their success factors (production, quality, etc).

• Plan work for staff, assign daily claims and determine priorities of work done by staff.

• Set or recommend work performance standards.

• Review work procedures and recommend or change procedures to be more time/cost efficient.

• Assist with interviewing job applicants and make recommendations for hire as needed.

• Train, evaluate, and provide performance feedback to staff.

• Conduct employee counseling/corrective interviews with the assistance of Human Resources.

• Conduct claims presentations as assigned.

• Other projects and duties as assigned.