Claims representative Jobs in Downey, CA

Description

We are seeking a detailed-oriented and experienced Claims Manager to join our Claims leadership team. In this key role, you will oversee a dedicated team of claims examiners, auditors, and support staff, and monitor the department for regulatory compliance. You will be responsible for implementing and maintaining efficient claims adjudication processes that utilize technology to automate workflows and maximize the accuracy of claim payments.

The ideal candidate will demonstrate strong leadership and communication skills, fostering collaborative relationships with colleagues and team members. You will promote high-quality customer service and identify opportunities for workflow improvements to boost effectiveness and productivity. Additionally, you will research and resolve complex claims issues and develop standard operating procedures for handling various intricate claim scenarios.

Salary Range : $92,600 - $202,200 Annually

Qualifications

• High School Diploma
• Bachelor's Degree in Business Administration,

Health Care or other related field preferred or equivalent work experience,

preferred

specifically related to Medicare Advantage or managed care in a complex and

diversified healthcare or health insurance company

least 2 years managing personnel in a claims processing environment

billing practices, appropriate CPT coding initiatives, ICD-10 coding standards

related to specificity, as well as Revenue and HCPCS coding

arrangements and reimbursement methodologies and of health benefit plan

concepts

claim formats; familiarity with American Medical Association (AMA) and Centers

for Medicare and Medicaid Services (CMS) coding guidelines such as the National

Correct Coding Initiative (NCCI) edits and their relation to clinical logic in

claims adjudication

Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization

tools

such as HIPAA, DMHC, AB1455, and CMS reporting requirements

and private insurance regulations

thinking and the ability to apply knowledge at a broad level within a complex

academic medical center is essential

working hours of the department

conferences