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Claims Operations Manager
2 months ago
We are currently seeking a dedicated and experienced Claims Manager to join our esteemed healthcare organization. This role is pivotal in ensuring the efficient and accurate processing of medical claims within our dynamic team.
About Us:
As a leading healthcare provider, we are committed to delivering exceptional services to our diverse patient base. Our professionals are dedicated to maintaining high standards of care and operational excellence.
Why Work With Us?
- Attractive Salary Range
- Comprehensive Benefits Package including health, dental, and vision coverage
- Opportunities for Professional Growth
- 401k with Employer Matching
Key Responsibilities:
1. Oversee and manage a team of eight in the medical claims processing department, ensuring compliance with industry standards.
2. Evaluate and analyze medical claims for eligibility, coverage, and reimbursement accuracy.
3. Collaborate with healthcare professionals and insurance representatives to resolve claims-related issues.
4. Conduct audits on Medicare claims and implement strategies to enhance processing efficiency and minimize errors.
5. Stay informed on the latest industry trends and regulatory changes affecting medical claims.
6. Provide training and mentorship to claims processing staff to enhance their skills and knowledge.
7. Analyze claims data to identify trends and potential fraudulent activities.
8. Prepare and present reports on claims processing metrics to senior management.
9. Maintain thorough and accurate records of claims and related documentation.
10. Ensure adherence to HIPAA 5010 and Medicare Advantage guidelines.
Qualifications:
1. Bachelor’s degree preferred, or equivalent experience in medical claims.
2. At least 3 years of experience in managing medical claims.
3. Strong understanding of medical claims processes, including Health Claims and Medicare Advantage.
4. Familiarity with HIPAA 5010 regulations and experience with Medicare audits is preferred.
5. Excellent analytical and problem-solving skills to address complex issues.
6. High attention to detail and accuracy, with the ability to perform under pressure.
7. Proficient in claims management software and relevant applications.
8. Strong 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 contribute to enhancing our claims processing operations. We offer a supportive environment, competitive compensation, and opportunities for professional development.
