Medical Claims Manager

Garden City, New York
Sep 28, 2018
Nov 27, 2018
Job Type
Full Time
Career Level

Been around since 1972. Family feel type business that really does care about the employees.  New Claims System, Leading Technology, 8 Stop-Loss Carriers to place business with for competitive S/L rates, Premier Networks. 

Third Party Administrator specializing in Self-Funded Health Plans seeks an experienced Claims professional. The Claims Manager is responsible for the management of accurate and timely adjudication of claims according to contracted/non-contracted guidelines to ensure provider retention within various networks. The Claims Manager is also responsible for ensuring policies, procedures, workflows are administered appropriately. 

Qualities, experiences and road to success….

  • Minimum of 15 years of claims processing management experience.
  • Minimum of 10 years of solid experience in Healthcare Claims Processing within a Healthplan, HMO, TPA or IPA of both institutional and professional claims.
  • Ability to demonstrate strong knowledge of CMS regulations and requirements for claims processing.
  • Ability to demonstrate strong knowledge with NCCI edits, CPT / HCPCS coding and ICD coding.