Job Functions and Responsibilities:

· Minimum of five years of experience in a management role with responsibilities for supporting staff performing claims processing, customer service, health plan reporting and audits, encounter data submission, and other managed care administration duties.

· Knowledge of claims processing and eligibility software required; experience with EZCAP system maintenance, EZCAP data reporting.

· Working knowledge of medical terminology, CPT, and ICD-10 coding.

· Maintain current on all regulatory requirements with all applicable state and federal rules, regulations, and laws, including CMS, PHS, IRS, HIPAA, ERISA, COBRA, ACA, and the Knox-Keene Act.

· Responsible for management and oversight of Annual Plan Reporting/Data Validation, in coordination with the Compliance department.

· · Responsible for management and oversight of the annual ODAG/CDAG Timeliness Monitoring Project.

· Interacts effectively with various internal and external departments to provide assistance and information.

· Manages programs, operational activities, or projects; supervises, trains and evaluates the activities of personnel and/or coordinates and monitors the work of consultants and contractors; works with executives, managers to evaluate and implement goals, responsibilities, policies and procedures.

· Directly supervises the executive and administrative assistants, including work assignments, evaluating performance, recruiting and hiring for positions.

· Plans, analyzes and coordinates the development and implementation of administrative policies and procedures, reviews existing operational policies and procedures for compliance with federal, state and local regulations.

· Assists in the development and implementation of strategic planning, policy and procedures.

· Prepares reports, memoranda, and correspondence; and maintains statistical records.

· Designs and conducts analytical and evaluative studies, including fiscal and budgetary analyses of existing and anticipated programs or operations.

· Evaluates procedures, identifies and analyzes problems and issues and may implement and document new procedures.

· Promotes and maintains team cohesion; allocates and manages tasks and resources; and mentors, motivates, develops, and manages the performance of the Administrative Operations employees

· Sets and maintains standards and operating procedures for the team, with support from more senior employees

· Maintains strong working relationships with other internal groups

· Maintains team efficiency and safety by ensuring a safe working environment

· Proposes annual department budget, schedules expenditures, analyzes variances, and takes corrective action, with support from more senior employees

· Determines training needs for policy and procedure implementation and revision

· Participates in strategic decision-making and long-term planning for the department, with support from more senior employees

· Assesses and resolves personnel and operational situations using professional judgment and involves other parties when appropriate

· Participates in management meetings and informs company policy at the appropriate level

· Experience in writing reports using SQL, Microsoft Access, Excel, and Crystal reports.

· Performs other duties as assigned

Requirements:

· Bachelor’s degree or equivalent in healthcare or related field

· 5 years of relevant work experience in managed care/HMO healthcare setting

· 3 years of leadership experience

· Excellent organizational skills and attention to detail

· Excellent oral and written communication skills

· Adept at Microsoft Office Suite

· Able to work occasional evenings and weekends

· Adept at department and company policies, workflow, and operating procedures

· Skilled in recruiting, training, and mentoring employees

· Skilled in budget management

· Skilled in managing service contract requirements and verifying invoices

· Strong leadership and managerial skills

· Skilled in supervisory practices and work coordination

· Strong understanding of the company’s business activities

· Skilled in overseeing resources and team priorities

· Skilled in developing a high-performing team

· Skilled in addressing team members’ conflicts

Job Type: Full Time

Job Location: Bakersfield, California

Competitive Salary
Health Insurance
Dental Insurance
Vision Insurance
401K
Life Insurance
Paid Time Off

Job Type: Full-time

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift

Supplemental pay types:

• Signing bonus

Ability to commute/relocate:

• Bakersfield, CA 93309: Reliably commute or planning to relocate before starting work (Required)

Willingness to travel:

• 25% (Preferred)

Work Location: One location

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