Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

Description

Play a vital role on our Claims leadership team, you will
manage a team of claim examiners, auditors, and support staff toward
operational excellence.

The Claims Manager of the Medicare Advantage Plan will:

• Implement and maintain efficient and streamlined
  claims adjudication processes that effectively utilize technology to automate
  business processes and maximize the accuracy of claims payments.
• Foster a positive, high-performing team culture
  focused on quality and exceptional customer service
• Identify opportunities to enhance workflows,
  resolve complex claim issues, and develop practical standard operating
  procedures
• Empower the team to navigate challenging
  scenarios with confidence and consistency

Salary Range: $98,200 - $214,600/annually

Note: This position is flexible-hybrid.

Qualifications

We’re seeking a self-motivated, service-driven leader with:

Required:

• Bachelor’s
  degree in business, health care or a related field and/or equivalent work
  experience

• Five
  or more years of claims operations experience in a Medicare Advantage or
  related environment

• Three
  or more years of managing personnel in a claims processing environment

• In-depth
  knowledge of physician and facility billing practices, CPT coding
  initiatives, ICD-10 coding standards, and revenue/HCPCS coding

• Understanding
  of provider network/IPA arrangements and reimbursement methodologies, etc.

• Knowledge
  of standard electronic and paper claim formats

• Familiarity
  with AMA and Centers for Medicare and Medicaid Services coding guidelines

• Computer
  proficiency with Microsoft Office Suite and data visualization tools

• Knowledge
  of HIPAA, DMHC, AB1455, and CMS reporting requirements

• Background
  with claims editing software (e.g., Optum CES, Web Strat, Mc Kesson, etc.)

• Experience
  in implementing and managing Prospective Payment System vendor application
  (Optum PPS, Micro Dyn, 3M, etc.). (preferred)

• Expertise
  with one or more of the following managed care transaction systems:
  EPIC (Tapestry Module), EZ Cap, Facets, QNXT

• Excellent
  problem identification, resolution, and analytical abilities

• Strong
  communication, interpersonal, and analytical skills

• Ability
  to develop, implement, and evaluate methods/systems to improve efficiency

• Ability
  to lead and facilitate cross-functional workgroups

• Proficiency
  in achieving compliance with regulatory requirements

• Ability
  to travel/attend off-site meetings and conferences

Preferred:

• Certified Professional Biller (CPB)
• Certified Revenue Cycle Representative (CRCR)