Director of Medical Claims

Job Description

Experience

• 10 years in healthcare claims or revenue cycle management with at least 5 years of managerial experience.
• Strong analytical and problem-solving skills, with the ability to independently learn new concepts and apply them effectively.
• Ability to review, interpret, and validate complex reports and data sets.
• Excellent communication and interpersonal skills, with a focus on collaboration, team development, and influencing without direct authority.
• Medicare guidelines and healthcare claims regulation knowledge.
• Medicare Advantage claims adjudication is a plus.
• Familiarity with delegated claims audits and payer compliance requirements preferred.
• Proficiency in claims systems (e.g., EZCap, EZEDI, or similar) and Microsoft Excel. Experience with EMR software is a must.

Essential Job Duties & Responsibilities