This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Manager, Medicare Claims. In this role, you will oversee end-to-end claims services for provider segments, ensuring we meet our business goals. Your leadership will help establish performance targets and manage the claims processing and financial aspects, while also maintaining compliance. Your collaboration with claims leadership will be vital in aligning with customer needs and fulfilling contractual obligations, ultimately enhancing the experience for all stakeholders involved.
Accountabilities- Streamline shared processing to reduce management by exception
- Set operational processes to align with market trends and customer demand
- Manage accounting and financial reporting functions to ensure compliance with standard practices
- Participate in projects to enhance claims processing and recovery functions
- Oversee financial recovery activities including refunds and collections
- Lead team and staff to optimize work volume and engagement
- Resolve complex claims appeals by coordinating with stakeholders
- Collaborate with Audit and Payment Integrity to ensure accuracy and quality
- Develop tools and techniques for process improvements
- Serve as the Medicare Claims Subject Matter Expert and primary contact for performance monitoring
- Represent Claims Operations in monthly calls with CMS and provide updates and expertise
- Engage with Compliance and regulatory entities, particularly CMS
- Bachelor's degree or advanced degree in a relevant field
- 8+ years of experience in a related field, with 10+ years in lieu of degree
- Strong analytical skills and ability to manage operations effectively
- Experience in Medicare and Medicaid or highly regulated environments is a plus
- Familiarity with accounting principles and compliance policies
- Skills in claims management and resolution
- Opportunity to work at the forefront of health care delivery
- Work-life balance, flexibility, and autonomy
- Medical, dental, and vision coverage with various wellness programs
- Parental leave support and assistance for adoption and surrogacy
- Career development programs and tuition reimbursement
- 401k matching with an annual contribution
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
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