Claims Manager - Medical Facilities at Roth Staffing Companies in Diamond Bar, California

Job Description:

We are looking for a Claims Manager to join an established company!
On-site in Diamond Bar, CA
$85k-$100k Annually


KEY DUTIES AND RESPONSIBILITIES:
* Provide an environment that allows staff members to flourish in their work duties. Quality levels of 99% maintained throughout the department.
* Continuous training of staff on responsibilities as well as on all enhancements and updates to claims regulations and company policies.
* Develop procedure changes to improve results. Corrective action plans developed and implemented to remediate any shortcomings in goal achievement.
* Maintain quality goals and production levels within the Department to ensure quality and production goals associated with each work area are consistently met by staff during their regularly scheduled work hours.
* Create, maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet the requirements.
* Track and trend the metrics associated with the claims adjudication.
* Prepare and present written and verbal reports.
* Research complex problem areas within the department or within the systems used by department and identify the root cause of these issues and recommend corrective actions.
* Supervise staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
* Perform special projects and ad-hoc reporting as necessary. Projects will be complete, and reports will be generated within the specific time frame agreed upon at the time of assignment.
* Working with internal departments to resolve issues preventing claims processing or enhancing processing capabilities.


QUALIFICATIONS:
* 4+ years processing claims/invoices experience preferred.
* At least 3-5 years of experience as claims examiner working with medical facility claims
* At least 2-3 years of lead/supervisory experience.
* Experienced in working with Provider Dispute Resolution (PDR's).
* Must have extensive experience in handling claims appeals with experience in communicating with external providers.
* Sound understanding of health care code sets including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), ICD-10 and revenue codes required.


All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.