Supervisor Payment Integrity
Supervisor Payment Integrity
Salt Lake City, UT; Lewiston, ID; Portland, OR; Seattle, WA
Responsible for leadership and oversight of teams that identify coding/billing errors, correct, adjust, recover, and prevent incorrect claims payment. Oversees the development and implementation of claims payment reviews and decisions support systems/tools that improve the effectiveness and efficiency for the Investigation and Validation department. Works closely with external vendors/suppliers to coordinate the day to day operations activities.
Responsibilities & Requirements
Achieving our ambitious Cause requires exemplary leadership. In addition to the Cambia values listed above, our leaders demonstrate the following leadership attributes: Cambia leaders think big, push boundaries, envision possibilities, inspire and empower others. They build collaborative relationships beyond their functional area and create workplaces which are just and transparent. Our leaders must be lifelong learners, develop others and act as role models for their teams, colleagues, external partners and—most importantly—our current and future members.
- Supervisor of Payment Integrity would have a bachelor’s degree in healthcare or related field and 4 years’ experience in a leadership or supervisory position as well as 7 years’ of member services/claim experience or equivalent combination of education and experience.
- Coding certifications preferable.
- Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
- Demonstrated competency in provider coding and billing practices.
- Ability to communicate effectively, with internal and external stakeholders, verbally and in writing, including meeting facilitation and presentations with external and internal partners. In possession of proven influencing skills.
- Ability to develop and lead a team including: hiring, goal setting, coaching and development (including employees who may be in multiple locations or work remotely).
- Demonstrated experience in recognizing problems and effectively resolving complex issues.
- Knowledge of claims processing functions including adjudication, audit and review, adjustment and recover, and claims inventory management.
- Demonstrated understanding in data collection, validation and analytics techniques.
- Ability to transform disparate pieces of information into an understandable framework and actionable recommendations.
- Strong operations skills such as experience with production work, process improvement and Audit reviews.
- Ability to identify issues, opportunities, and effective solutions and collaborate with other departments to improve processes and/or results.
- Demonstrated competency in resource and project management: budgeting, organizing work, providing leadership to staff, establishing measures for success, and managing to deliverables.
General Functions and Outcomes
- Responsible for supporting the department by developing, implementing and maintaining performance management tools and analysis reporting, scorecards and improvement; knowledge management documentation, training, tools and systems; and workforce management tools, training systems and analysis.
- Leads performance improvement initiatives within the Payment Integrity department as well as teams the individual is managing team.
- Leads the development and execution of new or revised procedures and standards. Oversees the implementation of process improvements as needed to ensure quality and service excellence.
- Handles all supervisorial level responsibilities for staff, including performance reviews, employee development, hiring, termination, coaching, counseling, and retention. Develops staff and participates in talent management activities.
- Regularly communicated organizational objectives and team goals. Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards. Collaborates with other leaders and across departments to resolve issues. In conjunction with division leadership, establishes long-term goals for department and adapts operation plans as changes occur.
- Develops resource materials and provides education and communication about programs to employees, other internal and external stakeholders.
- Support the preparation of analysis to support annual funding and budget forecasting.
- Ensures all targets and metrics are met through accurate forecasting of opportunity, costs, work volume, resources and productivity.
- Responsible for inventory management by performing capacity/demand with forecasting reporting.
- Ensures that claim reviews in production meet Cambia’s goals and quality standards, ensure alignment with business stakeholders and external suppliers.
- Provides consultation for and execution of strategic-level initiatives, capturing business needs, obtaining and validating data to identify opportunities, build business cases, influencing stakeholders and decision-makers, forming and leading cross-functional teams and driving delivery of initiatives start to finish
- Acts as an internal consultant and change agent within Cambia.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
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Cambia Health Solutions, headquartered in Portland, Oregon, is dedicated to transforming health care. We put people at the heart of everything we do as we work to make the health care system better and more economically sustainable for people and their families. Our company reaches more than 70 [...]