Monster
 
 

Job Summary

Company
HealthSpring
Location
Nashville
Industries
Healthcare Services
Job Type
Full Time
Employee
Career Level
Manager (Manager/Supervisor of Staff)
Job Reference Code
216772

Director of Claims (216772-955)

About the Job

Description

Responsible for directing claims functions to include managing, analyzing and ensuring accuracy of Medicare Advantage claims. Direct all activities for Provider Reimbursement, Savings and Recovery.  Conduct rolling goals and assess training needs of department. Consult with management team regarding promotional and educational opportunities.



Required Skills

  • Manage and identify areas of potential claims recovery, specific to COB, Subrogation/Third Party Liability.
  • Provide direction to management and supervise staff.
  • Recommend departmental procedural changes to assure claims payment accuracy.
  • Review and recommend vendor contracts.
  • Develop programs, claims policies and procedures interpretation as needed.
  • Consult with Compliance regarding HIPPA requirements.
  • Extensive claims knowledge of CMS Medicare Claims Payment claims payment procedures.
  • Knowledge of coding, billing and reimbursement based on industry standards for institutional, professional and ancillary claims processing.
  • Knowledge of CMS regulatory requirements.

. 

  • Manage and identify areas of potential claims recovery, specific to COB, Subrogation/Third Party Liability.
  • Provide direction to management and supervise staff.
  • Recommend departmental procedural changes to assure claims payment accuracy.
  • Review and recommend vendor contracts.
  • Develop programs, claims policies and procedures interpretation as needed.

Consult with Compliance Office regarding HIPPA requirements.



Required Experience

Minimum Requirements:  Bachelor’s degree or equivalent work experience.  Seven or more years experience in health insurance claim management.  Five or more years’ management experience. Broad knowledge of managed care concepts.

Preferred Requirements:  Savings and recovery coordination, Coordination of Benefits, Subrogation/Third Party Liability experience.
 
 

Job Tools

 
 

Contact Information

HealthSpring
9009 Carothers Parkway
Franklin, TN 37067

  Search for more jobs