Claims Quality Assurance Supervisor

Job not on LinkedIn

🔥 4 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $99.3k - $131.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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👻 Ghost score 0%

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WelbeHealth

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $30M Series C on 2020-02

Healthcare • Healthcare Insurance

WelbeHealth is a healthcare organization that provides comprehensive medical care and personalized support to help seniors age well at home and in their communities. They offer a Program of All-Inclusive Care for the Elderly (PACE) which includes services such as medical care and coordination, dental, vision and hearing services, in-home care, prescription deliveries, transportation, physical therapy, meals, social activities, and more, often at no cost to eligible seniors. WelbeHealth's dedicated team prioritizes the needs of seniors by offering a coordinated approach to healthcare, ensuring access to highly skilled professionals across various areas of healthcare, and emphasizing patient-centered care. Their goal is to improve the quality of life for seniors by enabling them to live independently with robust support from a multidisciplinary team.

📋 Description

• Develop and oversee a group of para-professional level team members • Lead claims quality assurance strategy and execution • Ensure accurate and timely claims payments while maintaining Medicare, Medicaid, contractual, and regulatory compliance • Drive continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration • Develop team members and strengthen workflows • Implement quality standards supporting operational excellence and accurate claims processing • Oversee auditing activities for accurate and timely claims payment • Identify operational issues and gaps, develop solutions, and recommend improvements to processing and training • Track progress and communicate audit results/status regularly to impacted parties • Recommend improvements based on identified trends and work with management and other departments to implement changes • Create and update team procedures, workflows, and resource materials • Monitor daily team member activities and report critical issues or concerns to management • Serve as primary resource and escalation point for quality assurance issues • Provide direct supervision, support, and guidance to team members • Evaluate performance and provide feedback, coaching, and counseling • Identify training gaps and opportunities for improved performance

🎯 Requirements

• Associates degree preferred or relevant professional experience in a health plan environment with an emphasis on billing, claims payment, coding and/or other closely related functions may be substituted • Minimum of five (5) years’ experience in health plans, i.e., managed care or PACE strongly preferred • Experience in claims processing environment, with an emphasis on claims auditing • Progressively responsible experience with demonstrated ability to mentor team members required • Working knowledge in Medicare and/or Medicaid billing and guidelines • Ability to understand and analyze contractual and regulatory requirements and their effect on claims payment and resolutions • Ability to process accurate information in a timely manner • Excellent leadership, organizational and communication skills • Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects • Comprehensive knowledge of claims processing and regulations • Strong problem solving skills and ability to analyze problems and formulate solutions • Proof of COVID-19 vaccination or a vaccine declination form required prior to employment

🏖️ Benefits

• Medical insurance coverage (Medical, Dental, Vision) • 17 days of personal time off (PTO) • 12 holidays observed annually • 6 sick days • 401K savings + match • Comprehensive compensation package including base pay and bonus • Additional benefits • COVID-19 vaccination policy and infection control/PPE standards

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