Under the direction of the VP of Healthcare Payment Systems & Prov. Data Mgt., the director assumes the overall management responsibility for claims processing and production. Working closely with internal and external customers, the position will provide a unique blend of customer service, procedural and technical knowledge. This director will provide business analysis for critical information requests, process re-engineering, business change management and metric analysis. Responsibilities will also include ensuring compliance and quality of medical payments, managing claims recovery efforts, working cooperatively with provider networks and other departments as needed to resolve provider payment issues, manage and monitor all claims customer service functions and manage business change priorities.

           

·        Manage overall work flow department and ensure overall compliance and quality of medical payments.

·        Proactively analyzes trends and metrics to alert senior leadership of opportunities to improve business performance.

·        Functions as a liaison for regulatory issues surrounding claims operations area.

·        Work cooperatively with provider networks and other departments as needed to resolve provider payment issues.

·        Investigates, initiates, and manages process and cost saving improvement initiatives.

·        Participates in planning and executes on the implementation of programs and strategies.

·        Provide guidance, coaching and performance management of the claims processing team and management staff.

 

·        Excellent organizational, attention to details and analytical skills required

·        Ability to meet deadlines and manage multiple priorities

·        Effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment

·        Ability to handle confidential information with professional ethics and integrity

·        Solid basic mathematical aptitude

·        Requires excellent professional, oral and written communication skills. Ability to effectively communicate both internally and externally.

·        Position requires a desire to constantly meet and improve internal and external service quality standards, which requires advance problem solving and technical skills associated with the claims processing industry.

·        Responsible for the supervision, training and development of claims analysts. Individual must have demonstrated leadership skills, including an ability to communicate with staff, peers and management.

 

·        Minimum 5 years of claims processing experience

·        Minimum 5 years of management experience in a production environment

·        Knowledge of CPT, HCPC, Revenue, and ICD9 Coding

·        Minimum of 5 years experience in health care, social services or with Medicaid or Medicare recipients. Managed care industry experience preferred.

 

Computer Skills:

Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word