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Director, Claims Operations
3 months ago
POSITION SUMMARY
We are looking for a highly skilled and strategic Director of Claims Operations to oversee all aspects of our claims department and ensure the accurate and efficient processing of healthcare claims. The ideal candidate will have a strong background in claims management, revenue cycle management, and healthcare operations, with a proven track record of implementing process improvements and driving results. This role requires excellent leadership skills, analytical abilities, and a deep understanding of claims processing systems and regulations.
RESPONSIBILITIES-DUTIES
- Develop and execute the strategic vision and goals for the claims department in alignment with the company's overall objectives.
- Lead and manage the claims operations team, including recruiting, training, and mentoring claims staff.
- Oversee the processing of healthcare claims, including claims intake, adjudication, payment processing, and resolution of claim disputes.
- Develop and implement policies, procedures, and quality assurance measures to ensure accuracy, efficiency, and compliance with regulatory requirements.
- Monitor key performance indicators (KPIs) and metrics to track claims processing performance and identify areas for improvement.
- Collaborate with internal stakeholders, including finance, legal, and IT teams, to optimize claims processes and systems.
- Stay current with industry regulations, coding standards, and billing guidelines to ensure compliance and minimize risk.
- Manage relationships with payers, providers, and other stakeholders to resolve complex claims issues and disputes.
- Develop and implement training programs and educational resources for claims staff to enhance skills and knowledge.
- Provide leadership and guidance to claims staff, fostering a culture of accountability, collaboration, and continuous improvement.
EDUCATION AND EXPERIENCE REQUIREMENTS
- Bachelor's degree in Healthcare Administration, Business Administration, or related field preferred
- Minimum of 8-10 years of experience in healthcare claims management, with at least 5 years of experience in a leadership role.
- Strong knowledge of healthcare claims processing systems, coding standards (e.g., CPT, ICD-10), and billing regulations (e.g., HIPAA, Medicare).
- Proven track record of implementing process improvements and driving results in claims operations.
- Excellent leadership, communication, and interpersonal skills, with the ability to motivate and inspire a team.
- Strong analytical and problem-solving abilities, with a focus on data-driven decision-making.
- Experience managing relationships with payers, providers, and other stakeholders.
- Knowledge of revenue cycle management principles and practices.
- Ability to thrive in a fast-paced environment and manage multiple priorities effectively.
- Relevant certifications (e.g., CPAM, CRCR) are a plus.
