Manages and supervises the Claims Team to ensure claims are paid properly and timely in accordance with Regulatory standards, Health Net standards, and contractual obligations
Job Summary
Manages and supervises the Claims Team to ensure claims are paid properly and timely in accordance with Regulatory standards, Health Net standards, and contractual obligations.
Identifies problem areas such as understaffing, customer complaints/issues, inefficiencies, and takes corrective action.
Provides direction, leadership and mentoring for all their staff and interacts with the client daily to resolve any issues, answer questions, and provide the production information as required.
Matching Summary
Manages and supervises the Claims Team to ensure claims are paid properly and timely in accordance with Regulatory standards, Health Net standards, and contractual obligations.
Skills & Requirements
Must-have
Healthcare claims quality auditing
Claims payment and compliance
Regulatory and contractual obligations
Exceptional customer service
HIPAA knowledge
Nice-to-have
Adding value-added options
Individual Development Plans
Performance evaluation procedures
Key Requirements
2 to 5 years of healthcare claims quality auditing experience
Bachelor’s degree or equivalent experience
Thorough knowledge of medical terminology, enrollment and membership activities, claim processing procedures/systems, auditing, and claim protocols and industry standards and CMS regulations
1-3 years prior health care claims processing experience
Supervise others by assigning/directing work; conducting employee evaluations; staff training and development; coaching and counseling