Director, Claims Administration

29 Apr 2024

Vacancy expired!

Complete Description

Oversight of claims subcontractor performance. Responsible for collaborating in the review of current and future integration to include medical management and web systems, which interface with the subcontractor's claims processing system. This position is also responsible for proactively and retroactively reviewing systems and claims for accuracy and efficiency. Leadership of and participation on multidisciplinary teams. Reviews and writes changes to promote error free claims processing.

Education & Experience

Required: o Bachelor's degree in Business, Health Care Administration, related field or equivalent experience

o 7 years' experience with health care claims experience.

o 5+ years of Supervisory experience/or project management

o Experience with business process and design analysis

o Experience with data management, statistical analysis, report design and presentation

Preferred: o Experience with government health care claims

o Skill with data queries

o HIPAA Compliance Knowledge

o Knowledge of Medicare Claims processing guidelines

o Claims coding experience

Key Responsibilities

o Collaborating in systems integration work between claim processing subcontractor and Government systems.

o Responsible for the preparation, review, and documentation of claims subcontractor changes to the subcontractor claims processing system. Propose needed system changes to increase productivity and/or accuracy.

o Review Government change orders for impact to systems and manage the work of the system analysts. Ensure that testing and documentation of changes is completed. Collaborates in ensuring interfaces between the claims systems and other systems are two-way, or other issues.

o Assists in the identification of key business issues. Evaluates and distills analyses conducted by other departments and/or outside consultants.

o Conducts quantitative and qualitative analyses on a broad array of issues across disciplines, projects and functional areas as assigned.

o Prepares preliminary interpretations of analyses for project teams, clients, and/or department management and recommends suggested action steps based on the analysis results.

o Work with internal departments to resolve Veteran and Provider issues.

o Management of Claims Subcontractor.

o Management of focused claims reviews including proactive and retroactive claims reviews to ensure claims accuracy and to identify system issues or processing issues.

o Management of claim recoupment efforts.

o Management of internal audit function.

o Manage invoice remediation processes.

o Work with subcontractors on claims issues.

o Review and approve internal claims processing guides.

o Manage claims inquiries and calls.

o Work with field liaisons to resolve claim issues for Veterans, Providers and VA.

o Other duties as assigned.

o Regular and reliable attendance is required.

Technical Skills: Research skills which include the interpretation of written policy, automated transactions and communication of the results of work items to appropriate management; ability to document trends and assimilate data; knowledge of UB04 and CMS 1500 claims billing criteria; ability to thoroughly research a transaction type from beginning to end. Knowledge of Systems, mainframe - oracle interfaces, visual basic and web systems. Knowledge with Microsoft Office Suite to include advanced Excel skills

  • ID: #39781210
  • State: Arizona Phoenix 85053 Phoenix USA
  • City: Phoenix
  • Salary: USD TBD TBD
  • Job type: Permanent
  • Showed: 2022-04-29
  • Deadline: 2022-06-27
  • Category: Systems/networking