HI,
Please go through the below JD and let me know your availability for this
need. If interested, please send me your updated profile to
glo...@visionisys.com
Job Description :
Position: Operations Claims Manager
Location: CorvaliS OR
Duration: 6 months
Primary skills: Operations Claims Manager
Job specific duties:
Manages and directs the Claims Department in conjunction with the Director
of Health Information. Responsible for the supervision, coordination and
ongoing operations of the department.
Oversees all requests for system projects, configuration and reports to
ensure compliant and efficient workflows and processes are maintained.
Oversees the investigation of potential COB, Medicare, MVA, third party and
Worker’s Compensation cases to pursue recovery opportunities, meeting
compliance and plan standards and policies.
Reviews audit reports and provide feedback to employees as necessary. Works
with audit staff to identify problem areas with staff and/or systems.
Coordinates solutions and implements programs to rectify issues. Ensures
that identified claims are reprocessed as necessary.
Coordinates, maintains liaisons with, and provides feedback to other
divisions, departments, providers and agencies to resolve problems or
discrepancies in processing claims or billing.
Ensures accuracy of explanation of benefits and checks generated from the
claims system. Maintains internal controls over accounting functions in the
claims processing area, including system generated capitation and member
reimbursement payments.
Continuously reviews department workflow and processes for efficiency.
Works with others, including SHS Information Services, to implement
required changes to ensure a highly productive and accurate processing
environment.
Accept and performs other work as assigned
Experience/Education/Qualifications
1. Bachelor's degree in healthcare or a related field, or 9 years direct
claims experience required.
2. Experience and/or training in Managed Care and claims processing
functions required.
3. Five (5) years’ experience in a health related field required.
4. Experience and/or training in collecting, analyzing, and displaying
statistical reports by computerized technology required.
5. Experience and/or training with basic medical terminology required
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