CTG SUPERVISOR, PROVIDER REIMBURSEMENT AND CLAIMS AUDIT in Rancho Cordova, California

Title: SUPERVISOR, PROVIDER REIMBURSEMENT AND CLAIMS AUDIT

Location: US-CA-Rancho Cordova

Job Number: 17203502

Supervisor, Provider Reimbursement and Claims Audit

Our client in the healthcare industry has a permanent, direct hire opportunity for a Supervisor, Provider Reimbursement and Claims Audit in Rancho Cordova, CA.

Our client is now one of the largest providers of Medicaid, Medicare Advantage, and other government-sponsored and commercial programs in the country. They provide access to affordable healthcare to more than 11 million members across the country. Our client’s employees are fast, agile, customer-focused multi-taskers with a commitment to implementing the latest technologies. If these same things get you excited, we hope to hear from you.

Job Description:

Supervise the day-to-day provider reimbursement or claims audit staff ensuring consistent workflow for accurate and timely processing of claims.


Ensure accurate and timely auditing and resolution of provider claim inquiries provider claims for payment accuracy to source documents (e.g. contracts)


Audit complex and escalated provider claims for payment accuracy to source documents (e.g. contracts)


Evaluate department audit and workflow processes, identify process improvements, and implement changes


Ensure all audits are compliance with policies and procedures. Standards, and various guidelines


Develop audit programs and workflow processes for new markets/products


Prepare and present reports on audit findings, issues, and action plans for resolution


Research and respond to escalated issues or questions


Lead and direct the work of provider reimbursement and claims audit staff

Qualifications:


Associate’s degree in related field or equivalent experience


6 years of combined medical or pharmacy claims processing, claims pricing, and supervisory or lead experience


1 year of experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring


training, assigning work and managing the performance of staff


Microsoft Office applications, Medicaid and Medicare reimbursement rules and the ability to interpret state and provider contracts required


Knowledge of CPT/HCPCS Coding required

To Apply:

Please use the link provided. For additional questions contact Sara Wade at sara.wade@ctg.com or call 716-882-8000 X 4908. W2 employees only, please no C2C. Referrals are appreciated!

Qualifications:

CTG is the most reliable IT services provider, built on 50 years of meeting our commitments to make technology work for clients and deliver real business value. CTG provides industry-specific IT strategy, services, and solutions that address the business needs and staffing challenges of clients in high-growth industries, including major technology companies, large corporations, and government entities located in North America and Western Europe.

CTG's greatest asset is its people, and as such we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work Company by Modern Healthcare (since 2013) in North America, and a Best Places to Work Company in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).

CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.

CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.

Job: Health Payer