Supervisor Appeals Operations
Cambia Health Solutions

Job Info

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SUPERVISOR APPEALS OPERATIONS

Telecommute Option - Must reside in ID, OR, UT or WA

WHO WE NEED

Supervisor Appeals Operations supervises the team and acts as a resource for Certified Professional Coders, and/or non-clinical support staff. Oversees 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.

Normally to be proficient in the competencies listed below

A Supervisor of Appeals Operations would have

• Bachelor's degree in healthcare or related field
  
• 3 years of leadership experience in the health insurance industry
  
• 5 years' of claim review, customer service or membership experience
  
• Or equivalent combination of education and experience.
  
• Coding experience strongly preferred.
  

Preferred Key Experience:

• Research, interpret and knowledge of Medicare, State and Federal appeal regulations
  
• Analyze data & reporting for volume trending and performance
  
• Adaptation and agility in a fast changing environment
  

FTEs Supervised

8-12

YOUR ROLE:

• 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 is in compliance with medical policy and medical necessity guidelines.
  
• Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings. Identifies and implements process improvements as needed.
  
• Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers. Collaborates with physician advisors on issues.
  
• Participates in the hiring process and provides on-going coaching, employee development and writing of performance reviews. Develops and maintains desk reference guides on work procedures. Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff.
  
• Completes special projects as assigned and may provide back-up support to staff as needed.
  
• May develop and present educational updates internally or to other departments.
  
• Seeks idea and opportunities for continuous improvement, determines which opportunities should be pursued and implements improvements as appropriate.
  

WHAT YOU BRING:

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
  
• Ability to communicate effectively, verbally and in writing.
  
• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work 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.
  

The base pay annual salary range is: 68.5k-112k

The bonus target for this position is 10%

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• paid time off and company holidays
  
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• one-time furniture and equipment allowance for employees working from home
  
• up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page.
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

This job has expired.