Directs and manages work assignments/duties to ensure smooth departmental operations in the areas of Claims Production, Mail Room operations, System Set-Up, Provider Dispute Resolution, Retro Review, and Medical Director Review.
Supervises all employees in areas of oversight. Assesses qualifications and hires candidates, assumes responsibility for the assessment and improvement of competencies, work assignments and schedules, orienting, coaching, training, in-services, performance evaluation, compensation, mentoring, discipline and terminating employment. Partners with appropriate departments in the necessary execution of these duties (e.g. human resources, risk management).
Responsible for Claims Production activity and to ensure the timely and accurate adjudication of claims in accordance with standard claims processing procedures, departmental policies and procedures, and regulatory standards.
Responsible for the ongoing monitoring and tracking of Claims Department inventory and adherence to the organizational goals for claims inventory.
Monitors Claims Production utilizing TAT reports, Production reports, and Denial Letter process.
Monitors Mailroom operations to ensure timely and accurate processing of batches, sorting of claims and correspondence, inventory levels, misdirected claims forwarding, and mail-back process.
Ensures follow-up on suspense and error reports to ensure that pending claims meets department turn-around times.
Develops, manages, and closely monitors department and staff.
Works with other departments to implement and maintain products and client services.
Attends administrative meetings and disseminates information to staff, when appropriate.
Oversees the development and implementation of standards of performance for department staff.
Provides guidance and training to department staff to ensure that department standards, organizational procedures and regulatory standards are met.
Ensures appropriate management of department staff, including timely completion of performance appraisals and corrective counseling, when necessary.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research... and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.