Medical Claims Manager
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.