Manager, Claims Processing

🕒 Maio 28

🐊 Florida – Remoto

🐊 Florida – Remote

💵 $78.400 - $107.800 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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CenterWell Senior Primary Care

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

⚕️ Seguro de Saúde

Healthcare Insurance

A CenterWell Senior Primary Care é um provedor de saúde focado em oferecer cuidados primários personalizados para idosos. A empresa enfatiza uma abordagem abrangente e holística para os cuidados de saúde, atendendo às necessidades físicas, sociais e emocionais dos idosos. Como parte de seus serviços, a CenterWell inclui assistência domiciliar e suporte farmacêutico para complementar seus cuidados primários para idosos. A organização está comprometida em oferecer estabilidade, benefícios inclusivos e oportunidades de crescimento profissional para seus colaboradores, mantendo uma cultura de respeito mútuo e atenção plena. A CenterWell é uma marca sob o grande grupo de saúde, Humana.

Descrição

• Oversee the review, adjudication, and resolution of home health, DME, home infusion and SNF claims, including Medicare, Medicaid, and commercial payer claims, ensuring compliance with payer guidelines, CMS regulations, and organizational policies. • Determine whether claims are paid, denied, returned, or adjusted based on clinical documentation, coding accuracy, authorization status, and payer requirements. • Manage escalated, complex, or high-risk claims issues, including denials, underpayments, and payer disputes. • Manage and develop claims processing professionals and/or claims supervisors; set performance expectations, provide coaching, and conduct performance reviews. • Identify, lead, and implement change initiatives to improve claims processing efficiency, denial rates, turnaround times, and cash flow. • Collaborate with Coding, Clinical Operations, Intake, Authorization, Finance, and Compliance teams to ensure accurate documentation and clean claim submission.

🎯 Requisitos

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field, or equivalent combination of education and experience. • 5+ years of progressive experience in claims processing, billing, or revenue cycle management within home health, DME, home infusion, SNF or related healthcare settings. • 2 or more years of people management experience • Comprehensive knowledge of all Microsoft Office applications, including Word, Project and Visio • Strong working knowledge of Medicare, Medicaid, and commercial insurance reimbursement, EDI claims, and healthcare billing systems

🏖️ Benefícios

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) • short-term and long-term disability • life insurance and many other opportunities