The Claims Resolution Projects Manager, under the general direction of the Vice President of Managed Care provides support and assistance for the Managed Care Department in connection with a variety of projects. The position is responsible for conducting research, organizing data and creating summaries that are used to assist and to resolve a variety of managed care claims issues. Claims issues would include but are not limited to underpayments; overpayments resulting in credit balances; claims issues as a result of incorrect contract set up in managed care payor's claims payment systems and a variety of other issues resulting from the incorrect application of contract terms. This position works with each Regional Director of Managed Care and is the primary claims resolution liaison between the Managed Care Department and the payor community. The Claims Resolution Projects Manager works closely with representatives of the Central Billing Office (CBO) and is the main contact for the CBO related to managed care claims issues. The Claims Resolution Projects Manager works in collaboration with each Regional Director of Managed Care to provide monthly updates on identified managed care claims issues to the Central Business Office. This position independently manages multiple strategic projects.
License or Certification:
- Associate's degree required. Bachelor's degree preferred.
- Two or more years related healthcare business office; managed care payor and/or financial and claims related experience
- Advanced knowledge of Microsoft Office products including Outlook, Word, Excel and PowerPoint is required
- Understanding of UB04 and other related claim forms and billing requirements
- Understanding of managed care payment methodologies including but not limited to per diem; per discharge; flat rate; fee schedule and other Medicare directed payment methodologies
- Understanding of Inpatient Rehabilitation Hospital payment methodologies and contracts preferred
Machines, Equipment Used:
- General office equipment such as computer/laptop, telephone, copy/fax machine, calculator, scanner, etc.
- Microsoft Office software, to include Outlook, Word, and Excel.
- Visual acuity, speech recognition, speech clarity.
- Ability to lift, lower, push, pull, and retrieve objects weighing a minimum of 30 pounds. Reasonable assistance may be requested when lifting, pushing, and/or pulling exceeds these minimum requirements.
Skills and Abilities:
- Oral communication, written communication, fluency in English, active listening.
- Information ordering, deductive reasoning, social perceptiveness, time management, critical thinking.
- Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner.
- Ability to work independently without continuous supervision.
- Indoor, temperature controlled, smoke-free environment.
- Handicapped accessible.
- May work under stressful circumstances at times.
Proficiency or Productivity Standards:
- Has regular, reliable, and predictable attendance and punctuality.
- Adheres to dress code including wearing ID badge.
- Adheres to Standards of Business Conduct.
- May be required to work weekdays and/or weekends, evenings if needed to meet deadlines.
- May be required to work on religious and/or legal holidays on scheduled days/shifts.
- May be required to perform other duties as assigned by supervisor.
- This position will support cultural diversity by promoting and maintaining an inclusive work environment and culture that is respectful and accepting of diversity.
Address: 16880 Balance Cove, Land O' Lakes 34638
Job ID: 2125223