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Medical Claims Supervisor
2 months ago
We are currently seeking a dedicated and experienced Claims Manager to join our esteemed healthcare organization. This role is essential in ensuring the efficient management of medical claims processing, contributing to our mission of delivering exceptional healthcare services.
About Us:
As a leading healthcare network, we are committed to providing comprehensive services to our diverse patient base. Our team is composed of highly skilled professionals who prioritize quality care and patient satisfaction.
Why Work With Us?
- Attractive Salary Range
- Comprehensive Benefits Package including health, dental, and vision coverage
- Opportunities for Professional Growth
- 401k Plan with Company Match
Key Responsibilities:
1. Oversee and manage a team of eight professionals in the medical claims processing department, ensuring compliance with industry standards.
2. Analyze and review medical claims for eligibility, coverage, and reimbursement accuracy.
3. Collaborate with healthcare providers, insurance companies, and other stakeholders to resolve claims-related issues.
4. Conduct audits on Medicare claims and develop strategies to enhance processing efficiency and minimize errors.
5. Stay informed on the latest trends and regulations in the medical claims industry.
6. Provide training and mentorship to claims processing staff to enhance their skills and knowledge.
7. Monitor claims data to identify trends and potential fraudulent activities.
8. Prepare and present reports on claims processing performance to senior management.
9. Maintain meticulous records of claims, payments, and associated documentation.
10. Ensure adherence to HIPAA 5010 and Medicare Advantage guidelines.
Qualifications:
1. Bachelor's degree preferred; relevant experience in medical claims may be considered.
2. At least 3 years of experience in managing medical claims.
3. Comprehensive understanding of medical claims processes, including Health Claims and Medicare Advantage.
4. Familiarity with HIPAA 5010 regulations; experience with Medicare audits is a plus.
5. Strong analytical and problem-solving capabilities.
6. Exceptional attention to detail and ability to work under pressure.
7. Proficient in claims management software and relevant applications.
8. Excellent communication and interpersonal skills for effective collaboration.
9. Proven leadership skills with experience in team motivation and guidance.
10. Ability to adapt to evolving industry regulations and technologies.
11. Experience with EzCap software is preferred.
12. Stable job history is essential.
Join our team as a Claims Manager and elevate your career in the healthcare sector. You will have the chance to significantly influence our claims processing operations while working in a collaborative and supportive environment. We offer competitive compensation, comprehensive benefits, and opportunities for ongoing professional development.
