Description |
As a member of Kaiser Permanente Colorado's team, you'll be proud of the contributions you make every day. From our financial professionals and IT team members to our RNs and physicians on the front line of care-we work together to advocate the health and well-being of our members, colleagues, and communities. And we do it all in an environment known for breathtaking scenery. Maintaining a close relationship with the natural beauty that surrounds them, the cities of Denver, Boulder, Longmont, and Colorado Springs offer something for everyone-from historic districts to family neighborhoods to world-class ski resort trails. Prepare to be inspired.
Supervises, coordinates & evaluates the activities of personnel engaged in processing Claims & Referrals in the Collections unit. Insures claims are accurately adjudicated & approved in accordance w/ departmental policies for the Rocky Mountain Region & Local Markets. Accountable for creating a culture of compliance, ethics & integrity. Maintains knowledge of & assures departmental compliance w/ KP's Principles of Responsibility & policies & procedures, & applicable regulatory requirements & accreditation standards. Responds appropriately to observed fraud or abuse.
Essential Functions:
- Supervises & coordinates the activities of personnel in the Collections unit
- Represents the organization's claims & referral process to include contract interpretation, implementation & compliance w/ Regulatory Agencies e.g. DOI, IRS, HCFA, NCQA
- Administers personnel policies & procedures w/ respect to counseling, disciplinary action & grievances
- Interviews, hires & evaluates department personnel
- Schedules & assigns work
- Approves time cards, vacations & other time off requests
- Evaluates & develops new & existing procedures, recommends & implements new procedures to improve operating efficiency & customer service
- Maintain current information & knowledge of all applicable Kaiser policies, local, state & federal laws & regulations, & accreditation standards
- Ensures that the training activities incorporate all applicable KP policies, local, state & federal laws & regulations, & accreditation standards
- Supervises assigned staff
- This includes interviewing, selecting, training, motivating, evaluating, counseling, disciplining & terminating in compliance w/ EEO/AA goals & personnel policies of the organization
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the KP Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
- Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors
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Requirements |
Basic Qualifications:
- 4 years of progressively responsible experience in a medical claims processing environment, including 2 years of supervisory and/or lead experience
- Experience in automated claims environment including workflow management
- Experience in Windows based system software programs
- Bachelor's degree or equivalent experience in business or health care related field
- Extensive knowledge of medical terminology, medical coding (e.g. CPT-4 & ICD-9), & state, federal, & Medicare regulations
- Working knowledge of various health insurance products such as PPO, HMO, POS & indemnity
Primary Location: Colorado-Denver
Scheduled Hours (1-40): 40
Shift: Day
Working Days: Mon-Fri
Working Hours Start: 8:00AM
Working Hours End: 5:00PM
Schedule: Full-time
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried Employees
Job Level: Team Leader/Supervisor
Job: Accounting, Finance and Actuarial Services
Public Department Name: Claims
Travel: No
Job Eligible for Benefits: Yes
External hires must pass a background check/drug screen. We are proud to be an equal opportunity/affirmative action employer.
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