What are the responsibilities and job description for the Claims Operations Delegation Oversight, Supervisor position at MedPOINT Management?
Summary
MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Physician Associations (IPAs) and hospital clients. The Claims Operations Supervisor of Delegation Oversight position plays an important, strategic client relationship role for IPA/hospital clients; their Health Plans; regulators; and claims operational areas. The Claims Operations Supervisor reports directly to the Senior Manager of Claims Operations, but also works closely with the Compliance Officer to execute primary responsibilities.
Duties and Responsibilities:
- Manage all Claims external audits/requests for information from business partners, ensuring consistent accuracy, timeliness, and compliant submissions
- Ensuring the data integrity and timeliness of all Claims audit requests (pre- and post-audits)
- Develop and maintain monitoring methods and tools to self-identify and correct potential non-compliant claims information (e.g., universes, sampled case files, CAPs)
- Support Claims team in developing root cause analysis and potential solutions to corrective action plans (CAPs) requested from auditors/clients
- Collaborates with internal SMEs from functional areas, who are liaisons to Claims and Compliance
- Create and maintain P&Ps that document Claims methods and protocols
- Working with functional SMEs, develop KPI reporting to perform ongoing internal monitoring, compliant performance for all Claims operational areas
- Assist with dashboard KPI reporting for Claims, Executive leadership, and Compliance, including proactive trend analysis to prevent/detect timely potentially noncompliant Claims scenarios
- Serve as the Claims representative in key Compliance meetings (i.e., weekly Compliance Huddles, Delegation Oversight Committee, and Compliance Committee), presenting Claims performance results, as necessary
Minimum Job Requirements:
- Strong familiarity with California State and CMS healthcare regulations & Claims experience
- 2-3 years experience working in Claims operations with a focus on compliance/operations
- Prior experience with government programs (Medicaid and Medicare), regulatory and compliance standards
- Knowledge and experience in Claims Operations, operational, and compliance areas for Medicare, Medi-Cal, and Commercial lines of business
- Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote)
- Ability to navigate EZ-CAP, Tableau, and Smartsheet
Skills and Abilities:
- Excellent written and verbal communication skills, especially re: P&P development and stakeholder messaging
- Ability to communicate with all levels of management and influence employees through strong communication and presentation skills
- Excellent organizational skills with the ability to balance several priorities
- Strong interpersonal skills
- Ability to make sound judgments and act professionally under pressure
Salary Range:
- $70,000-$80,000 annually
Salary : $70,000 - $80,000
