Supervisor of Payment Review

Supervisor Payment ReviewPortland, OR; Salem, OR; Medford, OR; Seattle, WA; Tacoma, WA; Burlington, WA; Salt Lake City, UT; Lewiston, ID; RemoteSupervisor Payment Review 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 medical payments are appropriate and in alignment with contract provisions, proper coding, policy or regulatory compliance across multiple lines of business.Responsibilities* 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.Minimum Requirements* 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.Normally to be proficient in the competencies listed aboveSupervisor would have a bachelor’s degree in healthcare or related field and 3 years of leadership experience in the health insurance industry as well as 5 years’ of claim review experience or equivalent combination of education and experience.

Coding experience strongly preferred.Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions.

We offer a competitive salary and a generous benefits package.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need.

We’ve been here for members for 100 years.

Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management.

We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington).

Each plan is an independent licensee of the Blue Cross and Blue Shield Ass