Manager I Claims

Finance / Accounting - Claims Review and Adjusting

Healthcare / Health Services

Responsibilities in this senior position will include, but are not limited to:
Responsible for directing the planning, design, development, implementation and evaluation of policies and procedures that assure accurate, timely claims and encounter processing and provider inquiries (written or verbal).
Assure timely and accurate processing of Medicare claims and encounters, and respond to provider telephone calls, written inquiries, and appeals.
The compilation of all information and documents required for claims and encounter processing and related inquiries to assure compliance with all applicable rules, regulations, and external and internal policies and procedures
The review of provider contracts and configuration of these contracts within the claims processing system to assure accurate payments to our providers
Collaboration and communication with other SHP departments on claims and encounter issues, related projects and inter-departmental operations issues
Development and maintenance of well-defined processes to enter, adjust, manage and report claims and encounters data
Preparation and timely submission of management and regulatory reports
Generation of configuration requests to assure accurate, timely administration of providers claims and processing and reporting of encounters
Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts
Production and submission of reports as required
Analyze, track and trend claims and encounters data; identify any potential service or systems issues;implement interventions and determine success of interventions

Requirements:
BA/BS degree preferred with at least 5 years of relevant professional experience, and the following OR any combination of education and experience which would provide an equivalent background:
Minimum of 2 years of managerial experience at the department manager level preferred.
Minimum of 5 years of Medicare/Medicaid claims experience that demonstrates progressive growth within claims operations.
Extensive knowledge of claims policies and procedures, including industry standards from Medicaid, CMS, and CCI Edits.
Excellent oral and writing skills.
Highly developed quantitative and qualitative analytical skills.
Highly developed project management skills.

All your information will be kept confidential according to EEO guidelines.