JOB SUMMARY
Responsible for the resolution of claims issues, including partnering with client delivery and providers.
ESSENTIAL DUTIES AND RESPONSIBILITIE
SInclude the following. Others may be assigned
- .
Supervise a team of claims personne - l.Manage claims inventory for multiple companies according to state and federal guidelines utilizing inventory management systems and report
- s.Team with other departments to resolve departmental/employee issu
- esReview and update policies and procedur
- esManage the work behaviors of all subordinate staff. Coach, counsel and reward as appropriate to individual performance. Deliver monthly/annual performance revie
ws
KNOWLEDGE, SKILLS, ABILIT
IESTo 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 functio
- ns.
General office equipment experi - enceMust have an excellent understanding of health and managed care concepts and their application in the adjudication of cla
- ims.Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes and medical terminol
ogy.
EXPER
- IENCE
2-3 years Supervisory/Management experience pref - erred.2-3 years claims experience in a managed care environment pref
- erred.2-3 years claims processing UB-04 and professional experience pre
- ferred3-5 years Medicare, Medicaid, Medical, Commercial, PPO and/or HMO claims experience pref
erred.
