CSI Companies is hiring a Healthcare Claims Operations Manager for our client, a Medicare Advantage health plan based in Spring Hill, FL
Hours: Monday-Friday, 40 hours/week, 8am - 5pm EST
Location: Spring Hill, FL; Hybrid (will be required onsite 1-2 days/week)
Position Type: Contract to Hire
Pay: $33-40/hour based on education and years of applicable experience
Job Summary:
The Claims Operation Manager is responsible and accountability for monitoring and overseeing the day-to-day operational functions and making sure accurate and timely release for all claims received. This role requires meticulous attention to detail, strong organizational skills, and a commitment to maintaining the highest standards of data integrity and confidentiality.
Job Responsibilities:
Manage the operational performance of claims payment accuracy and timeliness.
Provides regular monitoring and reporting of Key Performance Indicators (KPIs) and establishes 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.
Provides exceptional service to providers and proactively identifies 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.
Conducts 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.
Coordinates 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.
Implements and administers a robust configuration and claims quality and auditing program.
Qualifications
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
About Us
The 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 Offered:
Weekly pay
Medical, dental, and vision coverage
Voluntary Life and AD&D coverage
Paid Training
Opportunity for advancement upon performance and availability