Vice President Customer Service
Company: Regal Medical Group
Location: Los Angeles
Posted on: November 26, 2022
Regal Medical Group is looking to hire an experienced VP,
Customer Service to direct, empower, and lead operational
departments such as Claims and Customer Service in meeting all of
the objectives and compliance goals. To maintain in strict
confidence, all MRG/HPN, member, provider and Health Plan
information to which Vice President of Operations has access.
Essential Duties and Responsibilities include the following:1.
Coordinate the development of, and oversee the execution of Claims,
Customer Service, Human Resources and Facility/Mailroom operations
to ensure adherence to all contractual and regulatory
requirements.2. Perform the administrative functions such as
departmental budgets, financial planning and staff projections.3.
Oversee the training and resource material as needed.4. Oversee the
development of Policy and Procedures for Department as needed.5.
Support company activities such as company goals/strategy and
management meetings as required.6. Interpret the contracts and
claims for the appropriate payment and benefit determination.7.
Create and run reports for department oversight, and compliance
issues.8. Represent the Claims Department in Operation, Committee
and health plan Meetings.9. Oversee the Health Plan and regulatory
audits, and represent Claims in all audit processes.10. Keep senior
executive staff informed of operational activities.11. Develop
reports for internal and external reporting needs.12. Responsible
for meeting or exceeding established departmental goals such as
production standards, compliance, and claims accuracy.13. Evaluate
staff as part of interview or review process and make
recommendations for employee hiring, firing, and/or retention.14.
Other duties as assigned.
Education and/or Experience:
- Bachelor's degree or 5+ year's working knowledge of claims
processing and customer service operations.
- Strong call center management experience required.
- Extensive experience in managing large claims staff, with
multiple health plans, products and regions.
- Excellent professional and hospital claims adjudication
- Full working knowledge of TPL, COB, PPO, POS, HMO, ASO and
- Knowledge of DRG Grouper.
- Knowledge of CPT-4, HCPCS, Revenue and ICD-9 coding.
- Extensive knowledge of Medicare, and Medi-Cal.
- Knowledge of contracts and contractual interpretations for
payment and benefit issues.
- Strong knowledge of Microsoft Windows environment.
- Working knowledge of Microsoft Excel and Word.
- Excellent written and verbal communication skills.
- Strong organizational and leadership skills.
- Experience developing and producing management reports.
- EZ-Cap experience helpful.
Pay will commensurate with experience .
As one of the fastest growing Independent Physician Associations in
Southern California, Regal Medical Group, Lakeside Community
Healthcare & Affiliated Doctors of Orange County, offers a
fast-paced, exciting, welcoming and supportive work environment.
Opportunities abound, and enterprising, capable, focused people
prosper with us. We promote teamwork, nurture learning, and
encourage advancement for all of our employees. We want to see you
excel, because we believe that your success is our success.Full
Time Position Benefits:The success of any company depends on its
employees. For us, employee satisfaction is crucial not only to the
well-being of our organization, but also to the health and wellness
of our members. As such, we are firmly dedicated to providing our
employees the options and resources necessary for building security
and maintaining a healthy balance between work and life.Our
dedication to our staff is evident in our comprehensive benefits
package. We offer a very generous mixture of benefits, including
many employer-paid options.Health and Wellness:
- Employer-paid comprehensive medical, pharmacy, and dental for
- Vision insurance
- Zero co-payments for employed physician office visits
- Flexible Spending Account (FSA)
- Employer-Paid Life Insurance
- Employee Assistance Program (EAP)Savings and Retirement:
- 401k Retirement Savings Plan
- Income Protection InsuranceOther Benefits:
- Paid Time Off (PTO)
- Company celebrations
- Employee Assistance Program
- Employee Referral Bonus
- Business-casual working environment
- Sick days
- Paid holidays
Employer will consider for employment qualified applicants with
criminal histories in a manner consistent with the requirements of
the LA City Fair Chance Initiative for Hiring Ordinance.
Keywords: Regal Medical Group, Los Angeles , Vice President Customer Service, Executive , Los Angeles, California
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