Claims Manager
Company: HealthTexas
Location: San Antonio
Posted on: May 3, 2024
Job Description:
Job Purpose
The Claims Manager is responsible for overseeing and directing
delegated Managed Care Claims adjudication and manage our medical
claims department.
In addition, you will be responsible for contributing to the growth
and success of HealthTexas while upholding our Mission, Vision and
Values.
Culture and Values Expectations
At HealthTexas, we believe that our workplace culture is the
cornerstone of our success. We are committed to fostering an
inclusive, collaborative, and innovative environment where every
Associate feels valued, empowered and motivated to reach their full
potential. Our culture is the driving force behind our mission "to
deliver quality and compassionate care with outstanding service,
every patient, every time". As a Claims Manager at HealthTexas we
expect you to embody and promote our Values and defined behavioral
expectations.
- Integrity: Do the right thing, the right way, every time.
- Be honest and uphold commitments and responsibilities, earn the
trust and respect of the team and those we serve, and maintain
privacy and confidentiality.
- Compassion: Treat everyone with respect and dignity.
- Foster an environment of inclusivity and well-being, practice
patience and empathy, and assume positive intent.
- Synergy: Collaborate to improve outcomes.
- Invite and explore new opportunities, promote effective
communication and teamwork, take pride in yourself, your work and
HealthTexas.
- Stewardship: Use resources responsibly and efficiently.
- Implement effective strategies to attain goals, achieve maximum
productivity and results, and seek continuous knowledge and
improvement.
Essential Job Duties & Responsibilities
- Participate in inter-departmental business activities,
including input into budget preparation
- Prepare inbound and outbound 835, 837, EFT, etc.
- Encourage positive staff results by communicating job
expectations; planning, monitoring, and appraising results;
coaching, counseling, and implementing corrective action plans when
necessary; developing, coordinating, and enforcing systems,
policies, procedures, and productivity standards.
- Complete performance evaluations in a timely manner.
- Create, review, and/or update departmental procedures,
workflows, and resource material.
- Implement necessary policy and regulatory changes.
- Develop and manage auditing and quality control
standards.
- Supervise the coordination of workflow and staffing of
day-to-day activities as well as assigning and monitoring work of
staff in order to adhere to productivity and quality standards to
meet stated goals.
- Manage delegated claims audit and reporting.
- Ensure CMS and delegated claims compliance.
- Resolve and/or gather appropriate guidance for any escalated
issues.
- Other duties, as assigned
Experience
- Minimum 5 years medical claims adjudication working experience,
with at least 3 years of managerial experience
- Medicare guidelines and healthcare claims regulation
knowledge
- Delegated Medicare Advantage Experience is required
- Experience with claims adjudication software
Education
- Bachelor's Degree preferred. In lieu of a degree, 6 or more
years of relevant experience
Knowledge, Skills & Abilities
- Medicare guidelines and healthcare claims regulation
knowledge
Work Hours, Travel Requirements
- Monday - Friday, 8:00 a.m. - 5:00 p.m., and as needed to
complete projects.
- Travel to medical offices may be necessary for the purpose of
providing benefit education.
Working Conditions & Physical Requirements
- This job operates in an office setting. This role routinely
uses standard office equipment such as computers, phones,
photocopiers, scanners, filing cabinets and fax machines.
- The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. While performing the duties of
this job, the employee is regularly required to talk and hear. This
is largely a sedentary role; however, some filing is required. This
would require the ability to lift files, open filing cabinets and
bend or stand on a stool as necessary. Specific vision abilities
required by this job include close vision, distance vision, color
vision, peripheral vision, depth perception and ability to adjust
focus.
PM22
PId03a6fa08d83-31181-34060996
Keywords: HealthTexas, Austin , Claims Manager, Executive , San Antonio, Texas
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