Description: To manage and provide overall direction to the Claims Department staff ensuring efficient operations, compliance with policies and procedures and achievement of department goals and objectives that support organizational strategic plan.
This position is responsible for the claims processing functions and activities for a Knox Keene licensed organization (HMO).
Requirements: Ten (10) years of management level experience as a department Director or Manager in a Claims or Billing environment.
Bachelor's degree in Business Administration from an accredited institution or equivalent related field AND four (4) years of management or supervisory experience in a medical claims payment processing operation OR any equivalent combination of training and experience. Health maintenance organization (HMO) and Medicaid claims processing experience is highly desirable. Knowledge of managed care contracting methods; computerized on-line data entry systems; organizational structure of medical claims processing, and reimbursement methodologies; methods and procedures utilized in medical claims processing; supervisory and training techniques; medical terminology; fraud and abuse, and correct claim coding guidelines. Ability to adapt to a rapidly evolving work environment; work independently and manage multi-task responsibilities; communicate with a variety of personnel and providers; prepare a variety of comprehensive statistical and narrative reports; effectively supervise and train staff.
We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E.