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Claims Processing Lead
2 months ago
This role is for a dedicated and experienced Claims Manager within a leading healthcare organization. The ideal candidate will be instrumental in overseeing the medical claims processing operations, ensuring accuracy and compliance with industry standards.
About Us:
We are a reputable healthcare network committed to delivering exceptional services to our diverse patient community. Our focus is on high-quality care and continuous improvement in our operations.
Key Responsibilities:
- Lead and manage a team of eight claims processing professionals, ensuring precision and adherence to regulations.
- Evaluate and assess medical claims for eligibility, coverage, and reimbursement accuracy.
- Work collaboratively with healthcare providers, insurers, and other relevant parties to address claims-related issues.
- Conduct audits on Medicare claims and develop strategies to enhance processing efficiency and minimize errors.
- Stay informed on the latest developments in medical claims, regulations, and technology.
- Provide training and mentorship to claims processing staff to enhance their skills and knowledge.
- Analyze claims data to identify trends and potential fraudulent activities.
- Prepare detailed reports on claims processing metrics for senior management review.
- Maintain thorough and accurate records of claims and related documentation.
- Ensure compliance with relevant guidelines and regulations.
Qualifications:
- Bachelor's degree preferred or equivalent experience in medical claims.
- At least 3 years of experience in managing medical claims.
- Comprehensive understanding of medical claims processes, including Health Claims and Medicare Advantage.
- Familiarity with HIPAA regulations and Medicare audits.
- Strong analytical skills with the ability to resolve complex issues.
- Detail-oriented with the capacity to work effectively under pressure.
- Proficient in claims management software and relevant applications.
- Excellent communication and interpersonal skills.
- Proven leadership skills with experience in team motivation.
- Ability to adapt to evolving industry standards and technologies.
- Experience with EzCap software is preferred.
- Stable job history is essential.
Opportunity:
This permanent position offers a chance to significantly influence our claims processing operations while working in a collaborative environment. We provide competitive compensation, comprehensive benefits, and opportunities for professional growth.
