WelbeHealth - Claims Quality Assurance Supervisor
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 and 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 the ability to analyze problems and formulate solutions • If you’re a strategic, detail-oriented leader who is passionate about claims accuracy, regulatory compliance, and continuous improvement, we’d love to hear from you. Join us in strengthening claims quality, developing high-performing teams, and ensuring accurate, compliant claims processing that supports our mission to serve our participants. • Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.
Responsibilities
• Oversee auditing activities that claims are paid in an accurate and timely manner and in accordance with internal and external regulations and guidelines • Identify issues and operational gaps, develop solutions, and make recommendations for improvement regarding processing and training • Track progress and communicating audits results/status on a regular basis to impact parties • Make recommendations related to identified trends or improvements, and work with management and team members in other departments to implement changes, as directed by identified trends • Create and update team procedures, workflows, and resource materials • Monitor the results of daily team member activities, report critical issues and/or concerns to management • Serve as the primary resource and point of escalation of issues related to quality assurance • Provide direct supervision, support, and guidance to team members • Evaluate team member performance, provide feedback, coaching and counseling when performance issues arise. Identify training gaps and opportunities for improved performance
Benefits
• $99,309.58—$131,088.64 USD • COVID-19 Vaccination Policy • At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. • Our Commitment to Diversity, Equity and Inclusion
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