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Supervisor, Provider Dispute Resolution Intake Coordinator

Job Category:  Management/Executive
Department:  Claims Integrity
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  8251

 

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.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Supervisor, Provider Dispute Resolution (PDR) Intake is responsible for the daily management of the claims PDR Intake inventory and staff. This position oversees the assignment of incoming inventory and monitors the volume to ensure the department maintains the processing standards necessary for regulatory compliance. This position will perform audits to ensure the quality and timeliness of cases entered and routed through the PDR processing system. The Supervisor ensures assigned areas meet and maintain L.A. Care Health Plan's quality requirements and all State and Federal regulatory requirements. This position will work with the PDR management team to develop procedures ensuing the achievement of goals and will continuously monitor the work performed within the department. This position identifies and reports any issues and works with management to create clear and concise procedures for the handling of PDR Intakes.

Duties

Supervises the day to day activities of assigned staff, including but not limited to:  Staffing, work assignment distributions, and time off requests;  Monitoring of staff's performance including productivity and compliance with regulatory requirements; Handling all questions/issues raised by staff and escalating to the manager as necessary. Participates in hiring process, trains, mentors, and recommends corrective action in alignment with L.A. Care policies and procedures.  Provides timely input on staff performance. Recommends process improvement measures to achieve department's performance measures outcomes and goals. 

Oversees inventory and ensures the team has work for all functions. Alert Management team of any fluctuations with incoming inventory or changes in process. Update Management team on pending inventory on a weekly basis. Provides management with staff production metrics and coaches staff when metrics are not met. 

Oversees and supervises the following: Intake assignments, acknowledgment\resolution letter printing within compliance guidelines, rejection letters printing, creation of post service authorization requests received through PDR, sorting through PDR receipts to identify and correctly route provider issues to the following departments, Grievances and Appeals, Utilization Management, Medical Management, claims production floor and the PDR unit. 

Perform other duties as assigned.    

Education Required

High School Diploma/or High School Equivalency Certificate

Education Preferred

Experience

Required:
At least 3 years experience in provider dispute resolution Intake operations with at least 1 year of Lead/Supervisor experience. 

Must have extensive experience in handling claims appeals with experience in communicating with external providers.

Experienced in working with Providers Dispute Resolution's. 

Preferred: 
Healthcare experience.

At least 3-5 years of experience as claims examiner working  with medical facility claims and high dollar claims.

Experience working in a Medi-Cal managed care environment. 
 

Skills

Required:
Proficient knowledge and skills in Microsoft Office (Word, Excel).

Strong data entry and filing skills.

Ability to demonstrate a professional telephone manner.

Excellent verbal and written communication skills.

Strong customer service orientation to both internal and external customers. 

Must be dependable and able to prioritize and accomplish work with minimal supervision.

Must know Centers for Medicare and Medicaid Services(CMS) and Department of Managed Health Care (DMHC) timeliness requirement that pertain to AB1455 PDR Acknowledgment and resolution section.

Must enjoy working as part of a team.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information

 

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)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Claims, Data Entry, Medicaid, Medicare, Insurance, Administrative, Healthcare

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