A successful and growing company in the Healthcare industry is seeking a qualified Department Manager for Medical Claims Administration. This company is located in Austin, Texas. Pay, including benefits, will be commensurate with experience and knowledge. You may view our website at www.relapseprevention.org.
Oversees and directs the management of the claims function to include review and approval of claims. Directs the implementation and ongoing maintenance of claims handling systems, policies, and procedures. Monitors departmental operations to ensure compliance with regulatory agencies as well as contractual obligations. Performs regular data analysis of claims payment reports to identify variances so that areas of focus may be identified and resources may be appropriately deployed. Provides support on complex claims issues. Prepares and manages the departmental budget and manages expenses. Hires, develops, and motivates a qualified claims processing staff.
- Achieves defined productivity, timeliness, and quality standards in claims administration
- Motivates, trains, develops and retains a competent claims processing staff
- Assists with the development of workflows, processes, guidelines and training tools that will continuously improve the process
- Verifies the correct codes and bundling rules were used for claims and that payments were paid in accordance with billing and coding guidelines, payor-specific guidelines, payor contracts, and government rules and regulations, etc.
- Analyzes the accuracy of codes used to submit claims for payment against the reimbursement information on the Explanation of Benefits (EOBs), Explanation of Payments (EOPs), remittance advice, etc.
- Interfaces with customers for new client installation and to resolve problems or determine satisfaction with claim service
- Develops and functions within a defined budget
- Proactively works with customers (both internal and/or external) to resolve problems and to provide unsurpassed customer service
- Maintains thorough understanding of client specific and industry standards
- Achieves defined productivity, timeliness, and quality standards
- Maintains claims accuracy and turnaround time for all clients
- Prepares management reports identifying payment errors, trends in payment errors and payor performance issues
Qualifications and Experience:
- Five or more years of claims management experience
- College degree preferred with emphasis in management, finance, or accounting
- In-depth knowledge of healthcare standard codes (CPT, ICD, HCPCS, etc.)
- In-depth knowledge of commercial insurance reimbursement/payment policies, medical terminology
- Knowledge and understanding of medical coding and billing systems
- Proficiency in Microsoft Office Excel and Word
- Medical billing and collections experience in behavioral health or substance abuse, inpatient/outpatient facilities is a plus
- Must be willing to relocate to Austin, TX