Healthcare Claims Operations Manager

2 weeks ago

Tampa, Florida, United States Leading Edge Full time
Job Overview

Position Summary:
The Healthcare Claims Operations Manager is responsible for leading a dedicated team that manages the billing processes for healthcare services rendered to patients. This role emphasizes the development and dissemination of knowledge regarding products, benefits, quality standards, and organizational protocols. The manager ensures that claims are processed accurately in accordance with services provided, legal stipulations, and contractual agreements.

Key Responsibilities:

  • Oversee and direct the claims processing operations for clients, ensuring that performance metrics are consistently met or surpassed, while fostering a culture of positive feedback and recognition.
  • Recruit and manage personnel to maintain optimal staffing levels for efficient and high-quality claims processing.
  • Engage in effective resource allocation to enhance productivity and turnaround times.
  • Stay informed on Federal and State regulations; implement necessary changes related to claims and billing practices.
  • Establish, revise, and monitor performance metrics to achieve departmental quality, service time, and productivity objectives.
  • Track inventory levels and aging claims, assisting with workflow distribution as needed.
  • Provide expert support to teams in the review, research, investigation, negotiation, processing, and adjustment of claims.
  • Identify and coordinate resources for claim reprocessing.
  • Analyze trends and generate comprehensive reports for management review.

Qualifications:

  • A Bachelor’s degree in a relevant field such as business administration, accounting, finance, or equivalent experience in claims management.
  • A minimum of 4 years in a supervisory capacity within healthcare claims processing, with a strong understanding of HIPPAA and HITECH regulations.
  • Familiarity with benefit administration systems, preferably Javelina.
  • Comprehensive knowledge of Federal and State regulations governing healthcare fiscal operations.
  • Understanding of medical terminology and coding systems (ICD-9 & ICD-10).
  • Proficient in analyzing and resolving issues related to data collection, billing, and coding.
  • Ability to perform complex calculations related to claims processing.
  • Strong proficiency in standard office software including MS Word, Excel, Outlook, and PowerPoint.
  • Excellent communication skills, both verbal and written, with the ability to engage professionally with internal and external stakeholders.
  • Collaborative team player who supports collective goals and empowers colleagues.
  • Meticulous attention to detail and commitment to quality in all tasks.
  • Proficient in problem-solving and decision-making using available resources.
  • Ability to maintain confidentiality and exercise discretion in all matters.
  • Skilled in coaching and mentoring team members through effective communication.
  • Open-minded and willing to consider new ideas and approaches.
  • Demonstrates thoroughness and accuracy in work, ensuring high standards are met.
  • Effective at prioritizing tasks and managing time efficiently.
  • Adaptable to changes in the work environment and capable of handling multiple demands.
  • Responsive to feedback and committed to continuous improvement.
  • Builds trust and rapport with management, colleagues, and clients.

Physical Requirements: The physical demands outlined here are representative of those necessary for an employee to successfully perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

  • Constant: Communicate verbally and utilize hands and fingers for computer and telephone operations; occasional movement within the office.
  • Constant: Close vision required for computer work throughout the shift.
  • Occasional: Ability to lift and/or move up to 10 pounds.
  • Constant: Regular and predictable attendance is required.
  • Constant: Primarily sedentary role, with extended periods of sitting.

Work Environment: The work environment is typically indoors in a climate-controlled office setting, with a noise level that may range from low to moderate.

The responsibilities described are representative of the tasks that may be assigned and the skills required for the position. This description is subject to change at any time. Additional related duties may be assigned. This description does not alter the at-will status of employment.

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