[17062MSCRMCV] Operations Claims Manager

Hi,

                       

Please go through the below JD and let me know your availability for this need. If interested, please send me your updated profile to troy@visionisys.com

Here is the JD:

Position: Operations Claims Manager

Location: CorvaliS OR

Duration: 6 months

 

Primary skills: Operations Claims Manager

Job specific duties:

Manages and directs the Claims Department in conjunction with the Director of Health Information. Responsible for the supervision, coordination and ongoing operations of the department.

Oversees all requests for system projects, configuration and reports to ensure compliant and efficient workflows and processes are maintained.

Oversees the investigation of potential COB, Medicare, MVA, third party and Worker's Compensation cases to pursue recovery opportunities, meeting compliance and plan standards and policies.

Reviews audit reports and provide feedback to employees as necessary. Works with audit staff to identify problem areas with staff and/or systems. Coordinates solutions and implements programs to rectify issues. Ensures that identified claims are reprocessed as necessary.

Coordinates, maintains liaisons with, and provides feedback to other divisions, departments, providers and agencies to resolve problems or discrepancies in processing claims or billing.

Ensures accuracy of explanation of benefits and checks generated from the claims system. Maintains internal controls over accounting functions in the claims processing area, including system generated capitation and member reimbursement payments.

Continuously reviews department workflow and processes for efficiency. Works with others, including SHS Information Services, to implement required changes to ensure a highly productive and accurate processing environment.

Accept and performs other work as assigned

Experience/Education/Qualifications

1. Bachelor's degree in healthcare or a related field, or 9 years direct claims experience required.

2. Experience and/or training in Managed Care and claims processing functions required.

3. Five (5) years' experience in a health related field required.

4. Experience and/or training in collecting, analyzing, and displaying statistical reports by computerized technology required.

5. Experience and/or training with basic medical terminology required

 

 Thanks and regards

Troy      
Visionisys Inc, 
Ph : 630-315-0810
Email : troy@visionisys.com || http://www.visionisys.com
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