Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)
hace 2 meses
Los Angeles
Description Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence. The Claims Manager of the Medicare Advantage Plan will: • Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments., • Foster a positive, high-performing team culture focused on quality and exceptional customer service, • Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures, • Empower the team to navigate challenging scenarios with confidence and consistency Salary Range:$95,400 -$208,300/annually Note: This position is flexible-hybrid. Qualifications We're seeking a self-motivated, service-driven leader with: Required: • Bachelor's degree in business, health care or a related field and/or equivalent work experience, • Five or more years of claims operations experience in a Medicare Advantage or related environment, • Three or more years of managing personnel in a claims processing environment, • In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding, • Understanding of provider network/IPA arrangements and reimbursement methodologies, etc., • Knowledge of standard electronic and paper claim formats, • Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines, • Computer proficiency with Microsoft Office Suite and data visualization tools, • Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements, • Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.), • Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred), • Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT, • Excellent problem identification, resolution, and analytical abilities, • Strong communication, interpersonal, and analytical skills, • Ability to develop, implement, and evaluate methods/systems to improve efficiency, • Ability to lead and facilitate cross-functional workgroups, • Proficiency in achieving compliance with regulatory requirements, • Ability to travel/attend off-site meetings and conferences Preferred:, • Certified Professional Biller (CPB), • Certified Revenue Cycle Representative (CRCR)