Description
UCLA HEALTH
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Description
Play a vital role on our Claims leadership team, you will
manage a team of claim examiners, auditors, and support staff toward
operational excellence. The Claims Manager of the Medicare Advantage Plan 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. - Foster a positive, high-performing team culture
focused on quality and exceptional customer service - Identify opportunities to enhance workflows,
resolve complex claim issues, and develop practical standard operating
procedures - Empower the team to navigate challenging
scenarios with confidence and consistency
Salary Range: $95,400 – $208,300/annually
Qualifications
We’re seeking a self-motivated, service-driven leader with:
Required:
- Bachelor’s
degree in business, health care or a related field and/or equivalent work
experience - Five
or more years of claims operations experience in a Medicare Advantage or
related environment - Three
or more years of managing personnel in a claims processing environment - In-depth
knowledge of physician and facility billing practices, CPT coding
initiatives, ICD-10 coding standards, and revenue/HCPCS coding - Understanding
of provider network/IPA arrangements and reimbursement methodologies, etc. - Knowledge
of standard electronic and paper claim formats - Familiarity
with AMA and Centers for Medicare and Medicaid Services coding guidelines - Computer
proficiency with Microsoft Office Suite and data visualization tools - Knowledge
of HIPAA, DMHC, AB1455, and CMS reporting requirements - Background
with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.) - Experience
in implementing and managing Prospective Payment System vendor application
(Optum PPS, MicroDyn, 3M, etc.). (preferred) - Expertise
with one or more of the following managed care transaction systems:
EPIC (Tapestry Module), EZ Cap, Facets, QNXT - Excellent
problem identification, resolution, and analytical abilities - Strong
communication, interpersonal, and analytical skills - Ability
to develop, implement, and evaluate methods/systems to improve efficiency - Ability
to lead and facilitate cross-functional workgroups - Proficiency
in achieving compliance with regulatory requirements - Ability
to travel/attend off-site meetings and conferences
Preferred:
- Certified Professional Biller (CPB)
- Certified Revenue Cycle Representative (CRCR)