Manager, Preferred Technology Partners – Clearinghouse

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $119.6k - $191.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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OCHIN, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

💼 Consulting

🏥 Healthcare

🤝 Non-profit

Consulting • Healthcare • Non-profit

OCHIN, Inc. is a nonprofit health IT consultancy that partners with rural and community care organizations across the United States to advance equitable, whole-person care. For more than 25 years it has provided access to a shared EHR platform and integrated knowledge solutions, and it delivers Health IT, workforce training, operational/financial consulting, research, and advocacy to improve clinical quality, clinician well‑being, and sustainability for its national network of community health providers.

📋 Description

• Provide strategic oversight and day-to-day management of clearinghouse operations • Lead accurate and timely submission of electronic healthcare claims and management of remittance, eligibility, claim status, acknowledgment, and related EDI transactions • Supervise, coach, mentor, and develop the clearinghouse operations and implementation team • Establish operational standards, workflows, procedures, service-level expectations, controls, and escalation processes • Monitor queues, acknowledgment files, transmission reports, rejection worklists, and transaction volumes • Lead root-cause analysis and corrective action for transaction failures, claim rejections, connectivity issues, and processing delays • Develop business continuity and contingency processes for outages and disruptions • Lead onboarding and implementation projects for healthcare organizations and service expansions • Manage implementation scope, milestones, timelines, resources, dependencies, risks, testing, validation, migration, and deployment • Coordinate healthcare organizations, payers, vendors, Revenue Cycle, Information Technology, EHR, and practice management teams • Oversee payer enrollment, connectivity setup, configuration, data mapping, testing, and production deployment • Manage post-implementation stabilization and reviews • Own strategic relationships with clearinghouse vendors and EDI service providers • Manage vendor expectations, SLAs, performance reviews, scorecards, escalations, contracts, renewals, and risk mitigation • Partner with Procurement, Legal, Finance, Information Security, Revenue Cycle, and Information Technology on vendor management • Improve clean claim performance, reduce rejections and avoidable denials, and optimize revenue cycle efficiency • Analyze transaction data and establish measurable operational and financial improvement targets • Configure and maintain clearinghouse integrations, payer routing, claim edits, enrollment records, workflows, file delivery, and trading partner connections • Support migrations, platform upgrades, payer changes, acquisitions, and system implementations • Troubleshoot interface failures, data transmission errors, mapping issues, file processing problems, and system defects • Develop dashboards, vendor scorecards, implementation reports, and KPI reporting • Monitor clean claim rate, acceptance rates, rejection rates, transaction success, remittance processing, queue aging, vendor availability, SLAs, and implementation performance • Present performance, risks, implementation status, vendor issues, mitigation plans, and decisions to leadership • Ensure compliance with HIPAA, CMS requirements, ANSI X12 standards, payer requirements, contracts, and organizational policies • Support audits, security assessments, compliance reviews, and corrective actions • Hire, coach, mentor, evaluate, and develop team members; establish goals, accountability, training, workforce, succession, and growth plans • Perform other duties as assigned

🎯 Requirements

• Minimum of four years of hands-on technical experience working directly with healthcare clearinghouses or within a healthcare clearinghouse organization • Experience managing electronic claim submission, acknowledgment, rejection, remittance, and reconciliation workflows using Experian Health, TriZetto, Change Healthcare, Availity, or comparable vendors • Minimum of three years of leadership or supervisory experience managing operational, implementation, or technical teams • Experience leading healthcare organization onboarding and implementation in a clearinghouse environment • Ability to manage multiple concurrent implementation projects • Strong project management experience coordinating cross-functional teams, vendors, clients, payers, and technical stakeholders • Vendor management experience, including SLA oversight, performance reviews, issue escalation, contract support, and relationship management • Experience supporting healthcare revenue cycle operations and EDI transaction processing • Strong knowledge of electronic claims processing, payer connectivity, eligibility, claim status, remittance processing, and healthcare reimbursement methodologies • Working knowledge of HIPAA, CMS requirements, ANSI X12 standards, and healthcare data privacy and security requirements • Experience with EHR, practice management, billing, or revenue cycle technology platforms • Analytical, problem-solving, technical troubleshooting, and process improvement capabilities • Strong written and verbal communication skills • Proficiency in Smartsheet or similar project management system preferred • Working knowledge of Microsoft Word, Excel, and PowerPoint required • Legally authorized to work in the United States on a permanent basis at application • Must be able to read, speak, write, and understand English • Ability to work independently and efficiently from a home office • High-speed internet service • Distraction-free workplace • Must be vaccinated against COVID-19 or receive an approved medical or religious exemption before hire

🏖️ Benefits

• Generous compensation package • Remote work from a virtual home-office environment • Professional advancement opportunities • Work-life balance support • COVID-19 vaccination or approved medical/religious exemption accommodation • Up to 25% business travel support • Comprehensive benefits package • Equal opportunity protections for veterans and individuals with disabilities