Providence St. Joseph Health

Job Information

St. Joseph Health / Covenant Health Manager, Claims Support in Anaheim, California

We are looking for a Manager, Claims Support with HSS Admin

NSS Department at St. Joseph Heritage Healthcare.

Location: Anaheim, CA

Schedule: Full-time

Shift: Day

Job Summary:

This position is responsible for supporting timely and accurate claim and encounter processing for the claims service teams for all lines of business. Also responsible for any sources of revenue back to the networks based on HMO claims activity. Sources of revenue include third party liability (TPL), coordination of benefits (COB), termed members, over-payments and duplicate payments, health plan 3is (immunizations, injectables, infusion) and health plan capitation deductions. Direct reports include exempt and non-exempt staff. Supporting ongoing day-to-day production needs and creative problem-solving are a major focus. Outcomes of this work include continuous improvements in production, efficiency, quality and automation in order to meet and exceed the service expectations of members, providers, regulators, and health plan auditors.

Skills:

  • Proven leadership skills and ability.

  • Superior knowledge of HMO Claims Operations.

  • Demonstrated strong interpersonal skills.

  • Excellent verbal, written and public speaking skills.

  • Ability to manage a multi-disciplined, dynamic area, creating an inspiring work environment while achieving production and accuracy goals.

  • Strong organizational and process improvement skills.

  • Excellent team building skills, with demonstrated ability to work collaboratively in a matrixed environment.

  • Ability to manage multiple tasks while under pressure.

  • Demonstrated skills in motivating and leading staff and team members.

  • Ability to collaborate, negotiate, and reach consensus with others.

  • Ability to work with minimum supervision and manage events/projects effectively.

  • Ability to compile performance data into a format that drives strategic decision-making and process improvement.

  • Strong problem solving skills.

Position Requirements:

Education: Bachelor's Degree in Business Administration or healthcare related field Or equivalent educ/experience

Experience:

  • 4 years Relevant leadership experience in HMO Claims Department.

  • 6 years Related work experience in Claims

St. Joseph Health - Mission Heritage Medical Group is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, Mission Heritage Medical Group has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.St. Joseph Health - Mission Heritage Medical Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Heritage Medical Group complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Company: Heritage Healthcare

Category: Non- Clinical Lead/ Supervisor/ Manager

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