Claims and Referral Supervisor

JOB SUMMARY: Supervises, coordinates and evaluates the activities of personnel engaged in processing Claims & Referrals.  Insures claims are accurately adjudicated and approved in accordance with departmental policies for the Rocky Mountain Region and Local Markets.  Accountable for creating a culture of compliance, ethics and integrity. Maintains knowledge of and assures departmental compliance with Kaiser Permanente’s Principles of Responsibility and policies and procedures, and applicable regulatory requirements and accreditation standards. Responds appropriately to observed fraud or abuse. POSITION REQUIREMENTS:  Bachelor's Degree in business or health care or related field.  Equivalent experience will be considered.  Four years of progressively responsible experience in a medical claims processing environment, including two years of supervisory experience.  Previous experience in an automated medical claims processing environment required. Extensive knowledge of medical terminology, CPT-4 and ICD-9 coding. Thorough knowledge of state, federal and Medicare regulations pertaining to claims processing.  Working knowledge of various health insurance products such as PPO, HMO, POS and indemnity.  Effective verbal, written and interpersonal skills are required. ESSENTIAL RESPONSIBILITIES: Supervises and coordinates the activities of personnel in the Claims & Referral Department.Represents the organization’s claims and referral process to include contract interpretation, implementation and compliance with Regulatory Agencies. e.g. DOI, IRS, HCFA, NCQA.Administers personnel policies and procedures with respect to counseling, disciplinary action and grievances.  Interviews, hires and evaluates department personnel.Schedules and assigns work.  Approves time cards, vacations and other time off requests.Evaluates and develops new and existing procedures, recommends and implements new procedures to improve operating efficiency and customer service.Maintain current information and knowledge of all applicable Kaiser policies, local, state and federal laws and regulations, and accreditation standards.Ensures that the training activities incorporate all applicable KP policies, local, state and federal laws and regulations, and accreditation standards.Supervises assigned staff.  This includes interviewing, selecting, training, motivating, evaluating, counseling, disciplining and terminating in compliance with EEO/AA goals and personnel policies of the organization. ENVIRONMENTAL FACTORS: Standard office environment. SCHEDULE: Rotating schedule; Hols/wknds/nights; Floats between depts/locs/facs- Kaiser Permanente is an AA/EEO employer -  Additional Information Reference Code: AU.0800228 Position Type: Full Time, Employee Contact Information Lorraine Bamford Apply by Email Kaiser Permanente Colorado