Claims Manager

Location: Washington, DC
Date Posted: 03-14-2018
We are looking for a permanent Claims Manager for a great organization with top pay and benefits!

About us:
Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates.   We are created and managed by experienced industry professionals in healthcare. As a leading provider of direct hire, contract, and contract to perm recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.
Open Position:
The Manager, Claims Operations is responsible for the planning, development and implementation of administrative and operational Claims functions in adjudicating claims for authorized services, timely, accurately and consistent with member benefits and in compliance with contractual, State and Federal regulations. The incumbent will implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments. The Manager will establish methods for continuous monitoring/auditing of workflows to ensure the integrity and goals of the processes remain consistent and to identify potential opportunities for improvement. 

The Claims Operations Manager is accountable for the oversight and coordination of the following major functions: Claims Operations Program, Coordination of Benefits, Appeals and Overpayment Recoveries, Audit/Quality Control, Claims Edit Business Rules/Configuration, Retrospective Review, Customer Service, Claims Mailroom 

5 years of claims and management experience.
Must have extensive knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-9/ICD-10 coding standards related to specificity, as well as Revenue and HCPCS coding.  

For More Information:

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