Peyton Resource Group
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http://www.prg-usa.com
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USD
80000
YEAR
true
Job Purpose
The Claims Manager is responsible for overseeing and directing delegated Managed Care Claims adjudication and manage our medical claims department.
Essential Job Duties & Responsibilities
Experience
Education
Knowledge, Skills & Abilities
Work Hours, Travel Requirements
Claims Manager
Posted: 05/30/2024
2024-05-30
2024-08-26
Job Number: 21370
Pay Rate: 80000
Job Description
Job Purpose
The Claims Manager is responsible for overseeing and directing delegated Managed Care Claims adjudication and manage our medical claims department.
Essential Job Duties & Responsibilities
- Participate in inter-departmental business activities, including input into budget preparation
- Prepare inbound and outbound 835, 837, EFT, etc.
- Encourage positive staff results by communicating job expectations;planning, monitoring, and appraising results;coaching, counseling, and implementing corrective action plans when necessary;developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
- Complete performance evaluations in a timely manner.
- Create, review, and/or update departmental procedures, workflows, and resource material.
- Implement necessary policy and regulatory changes.
- Develop and manage auditing and quality control standards.
- Supervise the coordination of workflow and staffing of day-to-day activities as well as assigning and monitoring work of staff in order to adhere to productivity and quality standards to meet stated goals.
- Manage delegated claims audit and reporting.
- Ensure CMS and delegated claims compliance.
- Resolve and/or gather appropriate guidance for any escalated issues.
- Other duties, as assigned
Experience
- Minimum 5 years medical claims adjudication working experience, with at least 3 years of managerial experience
- Medicare guidelines and healthcare claims regulation knowledge
- Delegated Medicare Advantage Experience is required
- Experience with claims adjudication software
Education
- Bachelor’s Degree preferred. In lieu of a degree, 6 or more years of relevant experience
Knowledge, Skills & Abilities
- Medicare guidelines and healthcare claims regulation knowledge
Work Hours, Travel Requirements
- Monday –Friday, 8: 00 a.M. –5: 00 p.M., and as needed to complete projects.
- Travel to medical offices may be necessary for the purpose of providing benefit education.
- Position is 100% onsite, no remote work offered.
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