Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)
University of California - Los Angeles Health, Los Angeles, CA, United States
Description
Play a vital role on our Claims leadership team, you will
manage a team of claim examiners, auditors, and support staff toward
operational excellence. The Claims Manager of the Medicare Advantage Plan will:
Implement and maintain efficient and streamlined
claims adjudication processes that effectively utilize technology to automate
business processes and maximize the accuracy of claims payments.
Foster a positive, high-performing team culture
focused on quality and exceptional customer service
Identify opportunities to enhance workflows,
resolve complex claim issues, and develop practical standard operating
procedures
Empower the team to navigate challenging
scenarios with confidence and consistency
Salary Range:$95,400 -$208,300/annually
Note: This position is flexible-hybrid.
Qualifications
We're seeking a self-motivated, service-driven leader with:
Required:
Bachelor's
degree in business, health care or a related field and/or equivalent work
experience
Five
or more years of claims operations experience in a Medicare Advantage or
related environment
Three
or more years of managing personnel in a claims processing environment
In-depth
knowledge of physician and facility billing practices, CPT coding
initiatives, ICD-10 coding standards, and revenue/HCPCS coding
Understanding
of provider network/IPA arrangements and reimbursement methodologies, etc.
Knowledge
of standard electronic and paper claim formats
Familiarity
with AMA and Centers for Medicare and Medicaid Services coding guidelines
Computer
proficiency with Microsoft Office Suite and data visualization tools
Knowledge
of HIPAA, DMHC, AB1455, and CMS reporting requirements
Background
with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
Experience
in implementing and managing Prospective Payment System vendor application
(Optum PPS, MicroDyn, 3M, etc.). (preferred)
Expertise
with one or more of the following managed care transaction systems:
EPIC (Tapestry Module), EZ Cap, Facets, QNXT
Excellent
problem identification, resolution, and analytical abilities
Strong
communication, interpersonal, and analytical skills
Ability
to develop, implement, and evaluate methods/systems to improve efficiency
Ability
to lead and facilitate cross-functional workgroups
Proficiency
in achieving compliance with regulatory requirements
Ability
to travel/attend off-site meetings and conferences
Preferred:
Certified Professional Biller (CPB)
Certified Revenue Cycle Representative (CRCR)
Play a vital role on our Claims leadership team, you will
manage a team of claim examiners, auditors, and support staff toward
operational excellence. The Claims Manager of the Medicare Advantage Plan will:
Implement and maintain efficient and streamlined
claims adjudication processes that effectively utilize technology to automate
business processes and maximize the accuracy of claims payments.
Foster a positive, high-performing team culture
focused on quality and exceptional customer service
Identify opportunities to enhance workflows,
resolve complex claim issues, and develop practical standard operating
procedures
Empower the team to navigate challenging
scenarios with confidence and consistency
Salary Range:$95,400 -$208,300/annually
Note: This position is flexible-hybrid.
Qualifications
We're seeking a self-motivated, service-driven leader with:
Required:
Bachelor's
degree in business, health care or a related field and/or equivalent work
experience
Five
or more years of claims operations experience in a Medicare Advantage or
related environment
Three
or more years of managing personnel in a claims processing environment
In-depth
knowledge of physician and facility billing practices, CPT coding
initiatives, ICD-10 coding standards, and revenue/HCPCS coding
Understanding
of provider network/IPA arrangements and reimbursement methodologies, etc.
Knowledge
of standard electronic and paper claim formats
Familiarity
with AMA and Centers for Medicare and Medicaid Services coding guidelines
Computer
proficiency with Microsoft Office Suite and data visualization tools
Knowledge
of HIPAA, DMHC, AB1455, and CMS reporting requirements
Background
with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
Experience
in implementing and managing Prospective Payment System vendor application
(Optum PPS, MicroDyn, 3M, etc.). (preferred)
Expertise
with one or more of the following managed care transaction systems:
EPIC (Tapestry Module), EZ Cap, Facets, QNXT
Excellent
problem identification, resolution, and analytical abilities
Strong
communication, interpersonal, and analytical skills
Ability
to develop, implement, and evaluate methods/systems to improve efficiency
Ability
to lead and facilitate cross-functional workgroups
Proficiency
in achieving compliance with regulatory requirements
Ability
to travel/attend off-site meetings and conferences
Preferred:
Certified Professional Biller (CPB)
Certified Revenue Cycle Representative (CRCR)