Southern California Physicians Managed Care Services Looking for Healthcare Production & Eligibility Supervisor at San Diego, CA Full Time

Position Summary:

Supervises the daily activities of the Production Assistant(s), Eligibility Analyst(s), and Eligibility Assistant(s), Claims Assistant(s). Monitors and audits the electronic claims and eligibility process. Submits encounters as per TransUnion and Health Plan guidelines. Monitors the weekly encounter submission process. Collaborates with external vendors such as CHN and Office Ally, and internally, the SCPMCS’ Claims Supervisor and the IT department to ensure compliance with claims and eligibility processing timelines. Monitors mailroom equipment and outgoing mailroom functions.

Essential Job Functions:

• Supervises the daily activities of the Eligibility Analyst(s), Production Assistant, Claims Assistant, and Eligibility Assistant(s).
• Monitors and audits the electronic claims and eligibility process through EZNet to EZCap. Coordinates work assignments and, in collaboration with the Claims Supervisor and Manager, monitors compliance with timeliness guidelines.
• Collaborates with the IT department and external vendors (CHN, Office Ally, DataWing) to resolve enhancements, changes, and/or upgrades when needed.
• Conducts regular audits of staff performance and productivity. Completes monthly audit reports and reviews any issues with the Manager of Claims and Eligibility.
• Submits monthly encounter data reports to the health plans or health plans’ intermediaries as requested by the health plans and in HIPAA compliant format as determined by the IT department.
• Monitors the mailroom equipment which include the postage machine and folding and insert machine. Works with external vendors to report problems and schedule maintenance of these machines. Monitors outgoing mail processes. Serves as a back up to mail room duties.

Position Qualifications and Requirements

Experience/Specialized Skills:

• 2 years supervisory experience preferred. 2 years’ experience with claims or billing department process in the area of scanning and electronic claims process. Competent in the use of computer programs especially Microsoft Word, Access, and Excel and development of system reports.

Education/Course(s)/Training:

• High school diploma

Physical Requirements and Working Conditions

Must be able to perform the following physical activities with or without reasonable accommodation:

• Lift (standing/sitting): Frequently lift up to 10 lbs.
• Lift (standing): Occasionally lift up to 49 lbs.
• Pushing Occasionally push up to 49 lbs.
• Pulling Occasionally pull up to 49 lbs.
• Reaching (full extension/elbow flexion)
• Frequently reach above and shoulder level.

The following physical abilities are essential and are required frequently to perform job functions:

• Standing
• Sitting
• Walking
• Carrying
• Hand manipulation (simple grasping)
• Repetitive use of both hands
• Visual acuity
• Auditory acuity

The following physical abilities are essential and are required occasionally to perform job functions:

• Bending
• Stooping
• Kneeling
• Balancing
• Turning
• Twisting (standing/sitting)
• Hand manipulation (power grasping/fine manipulation)

Job Type: Full-time

Pay: $25.45 – $38.68 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 10 hour shift

Ability to commute/relocate:

• San Diego, CA 92121: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Are you comfortable working a 4 – 10 schedule?
• Do you have experience supervising 8 or more employees?
• Are you comfortable with this being a hybrid position?
• Do you have experience with EZNet?

Experience:

• supervisory: 2 years (Required)
• medical claims: 2 years (Preferred)
• billing process: 2 years (Preferred)
• Microsoft Office: 1 year (Preferred)

Work Location: One location