**Description**



Organizes and directs daily activities and department workflows to ensure accurate claims adjudication and payment integrity processes under the supervision of the Director of USFHP Health Care Operations. Responsibilities include ensuring accurate and timely accounting to Pacific Medical Center’s revenues and expenses for Outside Purchased Services (OPS), timely and accurate processing of claims and materials needed for accurate adjudication of claims. The ideal Supervisor will have experience with medical coding and claim auditing. Assures compliance with DoD and other government agency guidelines and contract requirements. Sets Claims policy and monitors compliance to same. Monitors Medicare and TRICARE coding and payment guidelines and educates staff in changes. Identifies and solves payment issues with outside providers. Serves as the principle contact with IT for Centricity night jobs, check runs and warehouse updates of claims materials. Ensure...