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Department:  Business Services
Status:  Full Time
Shift:  1st

Job Summary: 

The Supervisor of Encounter Data is responsible for managing all aspects of the Claims Encounter Process as well as supervising the Claims Encounter Team to ensure accuracy and compliance of all encounter submissions, including inbound and outbound transactions, to the health plans.


Essential Functions:

  • Oversee the encounter submission process including the outbound encounter process of Hoag Clinic’s encounter submission to the health plans and inbound encounter process of provider submission of claims to Hoag Clinic
  • Perform audit of the encounter submission process to help improve process and ensure compliance with regulations
  • Responsible for day-to-day activities surrounding the knowledge and insight for Encounter Submissions and critical issues impacting Encounter Submissions
  • Partner with key stakeholders including providers, health plans, clearing house, Hoag IT, Claims Operations, etc. to root-cause and monitor encounter data issues
  • Coordinate with Encounter Analysts and Claims Staff to implement all encounter data updates and enhancements
  • Manage communication between the health plans and the clearing house
  • Research and resolve encounter errors and provide direction to staff on error handling
  • Keep abreast of all regulations and changes impacting Encounter Submissions
  • Develop encounter data reports and deliverables to address claims discrepancies
  • Ensure team compliance and adherence to established team performance standards
  • Manage team production, workloads and priorities
  • Guide and direct successful completion of daily tasks. Responsible for onboarding, training, and development of team
  • Interact in a positive and collaborative manner. Alert claims management team of issues and trends observed in encounter processing, cost containment, and escalated claim issues
  • Perform other duties as assigned




Education, Training and Experience


Required: Bachelor’s degree in business/healthcare administration OR four (4) years of experience in a directly related field. 

Five (5) years of experience in encounter data submission, medical claims management, managing managed care staff, strong working knowledge of X12/ANSI HIPAA requirements, EDPS requirements, claims processing, configuration, extensive knowledge of regulatory guidelines in managed care (CMS, DMHC, DHS), working knowledge of professional and institutional claims processing procedures.


Preferred: Familiarity with Epic Tapestry managed care processing system


Skills or Other Qualifications


Required: Demonstrated leadership ability, collaborative, team-oriented approach to decision-making, ability to perform within a metrics and data-driven healthcare delivery system, strong interpersonal, verbal, and written communication skills, strong organization skills.



License and Certifications




Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Clinic, Database, Manager, Medical, Law, Healthcare, Technology, Management, Legal

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