Support Claims and Encounters business unit as the subject matter expert interfacing with all other business units to ensure processes align and complies with state regulation and mandates. Analyze regulations and contracts to document provider billing manual, Business Requirement Document, Report Document and training material.
Key Tasks and Responsibilities
• Manage Claims & Encounters team
• Oversee Encounters projects
• Test planning
• Develop and implement process improvement strategies
• Daily priority planning
• Assign and oversee daily staff assignment
• Oversee team standards and processes
• Develop staff scorecard and productivity
• Recruit and retain team resources
• Team coaching
• Handle escalated provider inquiries and disputes to claims payment
• Support monthly and adhoc reporting
• Claims and Encounters inventory management and reconciliation
Education & Training
• Required: High School Diploma or GED.
• Preferred: Bachelor Degree in Business, Health Administration, Computer Science or equivalent work experience.
Knowledge and Experience
• 5-7 years of healthcare experience
• 3-5 years of Encounters or relevant experience
• 3-5 years of management experience
• Significant MCO, Claims and Encounters knowledge/experience
• Knowledge of 5010 ANSI X12 (834, 837, 999 and 277CA)
• Excellent written and verbal communication skills
• Exceptional analytical skills
• Ability to communication and make recommendation for organization process improvement
• Strong problem-solving skills
• This is a Full time exempt position.
• Benefits include medical, dental, vision, voluntary life and 401(k)
• Some travel may be required as needed with possible overnight stay.