Job description

IMPORTANT: Please apply directly using the following link to be considered for this role.

https://www.pinnacletpa.com/about-us/careers/

Pinnacle Claims Management, Inc. (PCMI) is an all-inclusive Third Party Administrator (TPA) that offers competitive, affordable health benefits services to self-funded employers. Unlike other TPAs Pinnacle was born from a member-driven organization (Western Growers) and understands our client’s significance as a business partner. We place tremendous value in our relationships by offering TPA, PBM, ACA Compliance, and comprehensive Health Management services all in-house.

Compensation: $63,498 - $87,547 with a rich benefits package that includes profit-sharing.

Job Description Summary

This position reports directly to the Senior Director, Health and Wellness Clinical Services. The Supervisor, Clinical Services is responsible for overseeing the functioning of the assigned Health and Wellness Clinic. The management of daily operations of the outpatient clinic includes ensuring staff provide high quality, accessible, cost effective, and patient-focused care to members across the continuum of care in compliance with local, state, and federal requirements. The role is responsible for implementing and maintaining clinical practice standards, staff development, leading staff meetings, overseeing medical billing and reporting, implementing practice changes, ordering medical equipment and supplies, and resolving issues. The Supervisor, Clinical Services will support the delivery of nursing and patient care services that add value, are integrated with business plans, and meet or exceed quality, cost, clinical, and utilization standard and performance measures. This position's direct reports are front and back office clinical staff.

Qualifications

• Associates degree in a healthcare related field or Medical Assistant Certification with two (2) years or more of supervisory experience in an outpatient clinic required.
• In depth knowledge of medical terminology, ICD-10, and coding.
• Basic knowledge of insurance billing.
• Skilled in developing and implementing administration policies and procedures.
• Advanced communication skills, both verbal and written.
• Excellent customer service skills.
• Conflict management and problem solving skills.
• Verbal Spanish fluency preferred.
• Ability to work effectively with physicians, staff, patients, public and external agencies.
• Sound independent judgment and decision-making expertise.
• Proficient in Microsoft Word, Excel, Outlook, and Electronic Medical Record (EMR) systems.

Duties And Responsibilities

Clinic Operations

• Ensure compliance with all governing and accreditation agencies.
• Oversee the maintenance of the facility and equipment, ensuring adherence to all standards, rules, and regulations.
• Work with physicians to establish goals and long-term plans for the clinic and follow up with actionable policies to help the staff work towards and achieve those goals.
• Ensure staff provide the highest quality of care that follows the Nurse Practice Act, NCQA, TJC, and federal, state, and local requirements.
• Purchase equipment and supplies according to needs and budgeted costs.
• Oversee medical coding, collections and billing procedures, including tracking for delinquencies.
• Work closely with the claims management department to ensure that claims are submitted accurately.
• Handle customer service complaints and act as patient advocate to resolve patient care issues.

Staffing

• Hire and train support staff.
• Provide on going staff development, including evaluations and performance management.
• Ensure that all clinic staff follow company standards, policies and procedures.
• Manage schedules for all staff and ensure adequate coverage to meet clinical needs.
• Assist in managing and resolving human resource, labor relations, safety and risk management issues.

Reporting and Analytics

• Gather data and produce thorough reports of clinic efficiency and utilization.
• Analyze customer feedback to identify opportunities to improve customer satisfaction.
• Validate eClinical EMR reporting prior to submission to claims department.
• Review daily clinic utilization reports to identify and improve no-show rates and scheduled appointment completion.
• Maintain inventory data and utilize reporting to keep clinic fully stocked.

Management & Leadership

• Develop, manage, and lead a team of 3A+ self-accountable professionals.
• Develop a culture of authentic, personal accountability by modeling the behavior that defines it.
• Instill a culture of safety and expectation within your respective area/s.
• Require direct reports to hold themselves accountable to high performance standards and personal conduct in a clear, helpful, straightforward way.
• Conduct one-on-one conversations with every direct report quarterly focused on their 3A+ capabilities, impact, and effort.
• Make decisions and choices, impacting staff, using the steps outlined in the “Outward Mindset Skills for Leaders” guide.

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
• All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

IMPORTANT: Please apply directly using the following link to be considered for this role.

https://www.pinnacletpa.com/about-us/careers/

Job Type: Full-time

Pay: $63,498.00 - $87,547.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Vision insurance

Medical specialties:

• Primary Care

Schedule:

• Monday to Friday

Education:

• Associate (Preferred)

Work Location: One location

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