Supervisor of Appeal Operations
Cambia Health Solutions
Yakima, WA(remote)
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JOB DETAILS
JOB TYPE
Full-time, Employee
SKILLS
Artificial Intelligence (AI), Certified Professional Coder (CPC), Clinical Support, Coaching, Communication Skills, Continuous Improvement, Customer Support/Service, Establish Priorities, Health Economics, Health Insurance, Healthcare, Industry/Trade Analysis, Leadership, Maintain Compliance, Medical Coding, Medical Terminology, Medical Treatment, Needs Assessment, Operations Management, Performance Reviews, Problem Solving Skills, Process Improvement, Project Tracking, Quality Metrics, Regulatory Compliance, Set Goals, Staff Development, Systems Maintenance, Team Lead/Manager, Team Player, Time Management, Training/Teaching, Work From Home
LOCATION
Yakima, WA
POSTED
19 days ago
Work from home Within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated Supervisor Appeals Operations, are living our mission to make healthcare easier and lives better. As a member of the Appeal Operations team, our Supervisor Appeals Operations supervises the team and acts as a resource for Certified Professional Coders, and/or non-clinical support staff. Overseas and coordinates team activities to achieve business objectives and ensure the timely processing of member and provider claims and are in alignment with contract provisions, proper coding, policy or regulatory compliance across multiple lines of business, all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
* Bachelor's degree in healthcare or related field
* 3 years of leadership experience in the health insurance industry
* 5 years of claims review, customer service, or membership experience
* Equivalent combination of education and experience considered
* Coding experience strongly preferred
* Supervises 8-12 FTEs
Skills and Attributes:
* Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines
* Ability to communicate effectively, both verbally and in writing
* Ability to effectively develop and lead a team, including employees in multiple locations or working remotely
* Demonstrated experience in recognizing problems and effectively resolving complex issues
* Familiarity with health insurance industry trends and technology
* Knowledge of medical terminology and payment coding guidelines, as applicable
* Experience with AI tools and technologies to enhance productivity and decision-making in professional settings (highly desired)
What You Will Do at Cambia:
* Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings.
* Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and in compliance with medical policy and medical necessity guidelines.
* Assists in development of productivity and quality standards. Conducts or participates in compliance audits, reports audit findings, and identifies and implements process improvements as needed.
* Acts as a resource for staff and others. Appropriately escalates issues, partners with other departments to resolve issues and remove barriers and collaborates with physician advisors on complex cases.
* Participates in the hiring process and provides ongoing coaching, employee development, and performance reviews. Develops and maintains desk reference guides on work procedures, ensures new hires complete necessary training, and assesses training needs while playing an active role in staff development.
* Completes special projects as assigned and provides back-up support to staff as needed. May develop and present educational updates internally or to other departments.
* Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued, and implements improvements as appropriate.
#LI - Remote
The expected hiring range for a Supervisor of Appeal Operationsis $76,500 - $103,500 salary depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus
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About the Company
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Cambia Health Solutions
Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system.
Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that:
• help people achieve better health and well-being
• make health care more available, affordable and accessible
• are easily understood by everyone
We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans.
COMPANY SIZE
5,000 to 9,999 employeesINDUSTRY
Healthcare Services
FOUNDED
1940
WEBSITE
https://www.cambiahealth.com/careers