Senior Manager

3 weeks ago


Reno, Nevada, United States Prominence Health Full time
About the Role

Prominence Health is a value-based care organization that bridges the gap between affiliated health systems and independent providers. As a Senior Claims Manager, you will oversee the efficiency and accuracy of healthcare claims operations, ensuring timely and precise benefit determinations for claims while upholding exceptional service standards for members and providers.

Key Responsibilities
  • Oversee claims inventory, setting and evaluating metrics, and monitoring examiner production
  • Ensure compliance with healthcare regulations, including HIPAA and CMS guidelines
  • Implement quality processes and compliance standards, identifying areas for improvement and providing coaching to team members
  • Manage an efficient team, including hiring, managing, coaching, training, and motivating direct reports
Requirements
  • Bachelor's degree in healthcare administration or business management, or equivalent work experience
  • 5+ years' experience with a healthcare company or health plan, including leadership and budgeting experience
  • Strong leadership skills, with the ability to influence and persuade internally and externally
  • Knowledge of medical terminology, coding systems, and insurance billing practices
About Prominence Health

Prominence Health is a leading value-based care organization that creates value for populations and providers. We are committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.



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