Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

Salary Range: $98,200 - $214,600/annually

Note: This position is flexible-hybrid.

Required:

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• Bachelor’s degree in business, health care or a related field and/or equivalent work experience
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• Five or more years of claims operations experience in a Medicare Advantage or related environment 
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• Three or more years of managing personnel in a claims processing environment 
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• In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
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• Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.
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• Knowledge of standard electronic and paper claim formats
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• Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines
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• Computer proficiency with Microsoft Office Suite and data visualization tools
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• Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements
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• Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
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• Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)
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• Expertise with one or more of the following managed care transaction systems:  EPIC (Tapestry Module), EZ Cap, Facets, QNXT
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• Excellent problem identification, resolution, and analytical abilities
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• Strong communication, interpersonal, and analytical skills
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• Ability to develop, implement, and evaluate methods/systems to improve efficiency
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• Ability to lead and facilitate cross-functional workgroups
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• Proficiency in achieving compliance with regulatory requirements
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• Ability to travel/attend off-site meetings and conferences
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