Medical Claims Supervisor
2 weeks ago
The Claims Manager is responsible for overseeing and directing delegated Managed Care Claims adjudication and manage our medical claims department.
We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission “to deliver quality and compassionate care with outstanding service, every patient, every time”. As a Claims Manager at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.
Encourage positive staff results by communicating job expectations; planning, monitoring, and appraising results; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
Complete performance evaluations in a timely manner.
Create, review, and/or update departmental procedures, workflows, and resource material.
Implement necessary policy and regulatory changes.
Develop and manage auditing and quality control standards.
Supervise the coordination of workflow and staffing of day-to-day activities as well as assigning and monitoring work of staff in order to adhere to productivity and quality standards to meet stated goals.
Manage delegated claims audit and reporting.
Ensure CMS and delegated claims compliance.
Minimum 5 years medical claims adjudication working experience, with at least 3 years of managerial experience
Medicare guidelines and healthcare claims regulation knowledge
Experience with claims adjudication software
Bachelor's Degree preferred. Medicare guidelines and healthcare claims regulation knowledge
Work Hours, Travel Requirements
Monday – Friday, 8:00 a.m. – and as needed to complete projects.
Travel to medical offices may be necessary for the purpose of providing benefit education.
This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
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