Healthcare Claims Project Manager
3 weeks ago
Job Summary:
We are seeking a highly skilled and experienced Healthcare Claims Project Manager to join our consulting team at J29, Inc. This pivotal and dynamic role reports directly to the Program Director and offers significant growth potential.
Key Responsibilities:
Oversee and manage healthcare projects related to claims processing and payment.
Analyze and interpret Statements of Work (SOWs) and Requests for Proposals (RFPs) to identify opportunities, research solutions, and develop cohesive strategies for implementation.
Lead projects or manage subcontracted portions by thoroughly investigating opportunities and formulating strategies to ensure successful execution and compliance with client requirements.
Manipulate and analyze medical claims data in Excel, utilizing pivot tables and other advanced Excel techniques to identify trends and insights.
Manage and execute project budgets, ensuring resources are utilized effectively within the established budget.
Develop and implement strategies to improve claims processing efficiency and accuracy.
Collaborate with clients to understand their needs and provide tailored solutions.
Analyze and interpret claims data to identify trends, issues, gaps, or key areas of focus for the project at hand.
Ensure compliance with all relevant regulations and standards.
Coordinate with IT teams to manage file transfers and ensure data integrity.
Provide training and support to clients and team members on claims processing and payment systems.
Prepare detailed reports and presentations for clients and stakeholders.
Monitor project progress and adjust plans as necessary to meet deadlines and objectives.
Qualifications:
Minimum of 5+ years of experience in healthcare claims processing and payment.
3+ years of exposure to leading and managing programs that range from 3+ full-time resources and at/above $4M in total budget.
Experience working with multiple claim payment systems that support activities in the end-to-end claims processing flow.
Strong understanding of various claims processing files and file transfer processes.
Excellent project management skills with a proven track record of managing complex healthcare projects.
Strong analytical and independent problem-solving abilities in a fully remote environment.
Excellent communication and interpersonal skills working in a cross-collaborative environment.
Proficiency in relevant software and tools (e.g., Excel, MS Planner, MS Project, EncoderPro, Codify, SharePoint, Salesforce).
Ability to work independently and as part of a team.
Preferred Skills:
Experience in a healthcare consulting environment serving government programs.
Knowledge of healthcare regulations and standards.
Familiarity with claims related to Medicaid, TRICARE, and group health plans is a plus.
Management and leadership skills ranging from a team of direct or indirect reports that are supporting claims or record review.
Exposure to State or Federal contracts with direct engagement with government stakeholders.
Certification in project management (e.g., PMP, PRINCE2).
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