JOB SUMMARY
Responsible for the resolution of claims issues, including partnering with client delivery and providers.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
- Supervise a team of claims personnel.
- Manage claims inventory for multiple companies according to state and federal guidelines utilizing inventory management systems and reports.
- Team with other departments to resolve departmental/employee issues
- Review and update policies and procedures
- Manage the work behaviors of all subordinate staff. Coach, counsel and reward as appropriate to individual performance. Deliver monthly/annual performance reviews
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- General office equipment experience
- Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims.
- Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes and medical terminology.
EXPERIENCE
- 2-3 years Supervisory/Management experience preferred.
- 2-3 years claims experience in a managed care environment preferred.
- 2-3 years claims processing UB-04 and professional experience preferred
- 3-5 years Medicare, Medicaid, Medical, Commercial, PPO and/or HMO claims experience preferred.
