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Healthcare Claims Operations Manager
2 months ago
Career Opportunity with CSI Companies
Csi Companies is seeking a highly skilled Healthcare Claims Operations Manager to join our team. As a key member of our operations team, you will be responsible for monitoring and overseeing the day-to-day operational functions of our Medicare Advantage health plan.
Key Responsibilities:- Manage the operational performance of claims payment accuracy and timeliness.
- Provide regular monitoring and reporting of Key Performance Indicators (KPIs) and establish best practice claims payment methodology based on the latest CMS claims payment rules.
- Design and implement various policies and procedures or job aids for the department.
- Provide exceptional service to providers and proactively identify issues and problems through regular monitoring of KPIs.
- Provide training to juniors to manage all outstanding claims and design an efficient duty program and coordinate with the HR team to facilitate the same.
- Conduct root cause analysis on systemic issues and formulate an action plan to avoid incorrect payment to include a review of contracts, Medicare claims payment rules, internal system, and beneficiary impact.
- Coordinate with provider relations teams on any claim issues.
- Assist in pre-delegation and post-delegation audits, ensuring CMS and NCQA requirements are met.
- Forecast all staffing requirements and identify and resolve all issues effectively and schedule all employee attendance.
- Implement and administer a robust configuration and claims quality and auditing program.
- Bachelor's degree (B. A.) from four-year College or university
- 5 plus years related experience and/or training, or equivalent combination of education and experience.
- A minimum of 3 years of Medicare experience in Managed Care with a focus in claims and benefit configuration, claims operations internal and external; and payment accuracy
- Knowledge of CPT Codes, DRG, and ICD-10 billing coding for institutional and professional claims is required
Csi Companies is a recruiting firm established in 1994 that has been awarded "Best of Staffing" for nearly 10 years in a row. We provide outstanding services to the world's leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration. Only those candidates identified for an interview will be contacted.
Benefits:- Weekly pay
- Medical, dental, and vision coverage
- Voluntary Life and AD&D coverage
- Paid Training
- Opportunity for advancement upon performance and availability
