Guides the development and activities of an organized team.
Serves as the team’s primary contact and assumes management responsibility for the team(s). This individual may be backup in the absence of the Manager. Serves as subject matter expert. Interfaces directly with internal or external customers as well as trains new employees and resolves customer concerns within a team to meet or exceed customer requirements.
Supervises cross-functional team members to ensure all internal and external requirements are met.
Independently examines and analyzes the team’s performance; develops, recommends and implements plan(s) of action to improve the team’s service level. Reports on team service measurements against plan goals.
Leads and champions process improvement initiatives; identifies and shares best practices.
Identifies training needs within the team; works independently and/or through other sources to develop a training plan.
Recruits, attracts, develops, motivates and manages the day-to-day operational activity within the department.
Serves as product and process expert and resource to team(s).
Assist with third party audit preparation.
Leads team meetings.
Interfaces with all claim units to monitor and resolve all claim error rebuttals.
Maintains a positive work environment and provides a structure to optimize the experience, skill, knowledge and capability of the audit team.
Maintain the integrity of various types of databases.
Ensure the company auditing program is in compliance with the most recent operational procedures and all applicable regulatory guidelines.
Experience: 5-8 years.
5-6 years claims processing experience or combination of claims processing and direct customer service experience, or related industry experience 3-5 years claims auditing experience.
Will accept an equivalent combination of experience and education.
Computer Skills: Working knowledge of word processing, spreadsheets and databases knowledge of Microsoft Office software package.
Keyboard dexterity and accuracy.
Expert knowledge of medical terminology .
ICD-9 and CPT-4 coding experience.
Expert knowledge of and experience in processing and working with all types of products including HMO, PPO and Indemnity under both fully insured and self-funded arrangements.
Expert knowledge of coordination of benefits.
Excellent organizational, interpersonal and communication skills.
Ability to maintain production levels and quality goals.
Strong analytical and problem solving skills.
Ability to train employees on all products, procedures and systems.
Ability to manage multiple tasks simultaneously.
1-2 years supervisory experience preferred.
14100 Magellan Plaza (MO06)
14100 Magellan Plaza
Magellan Health Services is a leading specialty health care management organization with expertise in managing behavioral health, radiology and specialty pharmaceuticals, as well as public sector pharmacy benefits programs. We deliver innovative solutions to make a positive impact on the cost and quality of health care, keeping the best interests of the people we serve at the center of our decision-making. The breadth of our offerings, depth of expertise, clinical excellence and smart, talented employees is what makes us unique.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment where we value professional growth and development, total health and wellness, rewards and recognition and employee unity. Magellan is a place where you can thrive.
Magellan Health Services - 19 months ago
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