Claims Processing Supervisor

• Supports and contributes to AllCare’s mission, vision, and values.
• Maintains and monitors internal audit procedures to ensure staff compliance with departmental policies, procedures, and quality standards.
• Ensures claims processing procedures are followed consistently and provides coaching or retraining as needed.
• Maintains compliance with departmental policies and procedures related to HIPAA and protected health information (PHI).
• Reviews, develops, maintains, and updates claims processing procedures, reference materials, and training resources.
• Maintains a working knowledge of the duties, processes, and workflows performed by all positions supervised.
• Organizes team workflow and assigns responsibilities to ensure appropriate coverage, including during staff absences.
• Monitors individual and team productivity and quality and provides regular, constructive feedback.
• Identifies and addresses employee performance, attendance, and workplace concerns in accordance with organizational policies and procedures.
• Conducts performance evaluations for direct reports.
• Maintains clear and accurate documentation of employee performance discussions, coaching, and disciplinary actions.
• Identifies and communicates system needs, process improvement opportunities, operational concerns, and staff-related issues to department leadership.
• Demonstrates professional and respectful communication and behavior when working with employees, leadership, providers, and other stakeholders.
• Maintains punctual, regular, and predictable attendance.
• Works collaboratively within the department and across teams to support effective claims operations.
• Respectfully receives and follows direction from the Sr. Claims Processing Manager and/or VP, Claims Administration & Payment Integrity.
• Completes all required training, including assigned Relias Learning Management System (LMS) training.
• Performs other duties as assigned.

• Highschool Diploma or equivalent required.
• Bachelor's degree (BA) from a four-year college or university preferred; or equivalent combination of education & experience.

• 2–4 years' experience in managed care, Medicare, and/or Medicaid claims processing (or an equivalent combination totaling at least 2 years), with a solid understanding of core claims concepts such as co-pays, deductibles, co-insurance, coordination of benefits, and pre-existing conditions, and demonstrated knowledge of claims workflows and adjudication practices. 
• Extensive knowledge of medical terminology and coding systems, including ICD-9, ICD-10, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Diagnosis Related Grouper (DRG), Resource Utilization Groups (RUG), and Health Insurance Prospective Payment System (HIPPS) codes. 
• Knowledge of CMS 1500, UB-04, and other applicable claim forms, both paper and electronic. 
• Ability to research and resolve errors resulting in refunds and adjustments. 
• Prior supervisory, lead, or training experience strongly preferred. 

• AAPC certification such as CPC, CPB, or CPMA required within 12 months of hire. Equivalent nationally recognized coding, billing, or medical auditing certification may be considered.

• Familiarity with the Healthcare industry.
• Exceptional writing, editing, and proofreading skills.
• Excellent organization and time-management skills.
• Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
• Knowledge of and compliance with HIPAA regulations.
• Excellent at breaking a project into definable and measurable tasks and tracking progress to completion.
• Knowledge of research methodologies and/or data analysis. 
• Excellent at interpreting data and using it to solve problems and gain new insights. 
• Excellent at locating information and synthesizing information from various sources.
• Knowledge of customer service and service recovery best practices.
• Excellent customer service skills to respond appropriately and interact positively with upset customers.
• Knowledge of phone customer service best practices and experienced with multi-line call centers.
• Knowledge of training best practices and adult learning principles.
• Excellent at training development and/or delivery.
• Knowledge of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.

• Trust: Promotes honesty, transparency, and diligence. Approaches leadership with mindset of “power with” rather than “power over” and regularly includes others in planning and decision-making. Able to make and communicate difficult decisions in the best interest of AllCare Health.
• Innovation: Ready to take advantage of unexpected opportunities; adapts quickly to change and is a teacher to assist with change within the organization. Commits to solving unresolved issues in an effort to collaborate and model problem solving. Proactively develop solutions to challenges, including by constantly looking at big-picture progress and thinking about people.
• Relationships: Enthusiasm for meeting and engaging with people. Able to put people at ease, especially when there are lines of difference. Identifies and intervenes in problematic dynamics. Listens closely to understand needs or concerns and takes steps based on that input. Gets back to people in a timely manner. Takes pride in providing clear, helpful information.
• Voice: Brings a clear vision and recognizes the value of divergent perspectives. Provides equity-centered conflict transformation support, interventions, and training in the team and across departments. Commits to and understands concepts of equity, belonging, and inclusion in the workplace. Effectively works and collaborates across differences. A working knowledge and understanding of the ways implicit bias, personal identity, and power and privilege impact individuals, organizations and systems.

• The employee must be able to work onsite as needed.
• The employee may be able to work from a home office occasionally.

Company Overview

AllCare Health Website:  https://www.allcarehealth.com.

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others. 

If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.