Director, Claims
3 days ago
Description
• Oversee the end-to-end claims management process. • Lead a team of claims professionals. • Optimize workflows and drive strategic initiatives to improve claims operations. • Ensure accuracy, efficiency, and compliance with regulatory standards. • Develop, implement, and review dashboards, reports, and workflows to optimize efficiency.
Requirements
• Bachelor’s degree in healthcare administration, business, or a related field (Master’s preferred). • 8+ years of progressive responsibility, preferably in a managed care setting. • Knowledge of DMHC, DHS, and CMS regulations and guidelines. • Proficient in knowledge of CPT, HCPCS, ICD-10. • Strong knowledge of MSO operations, healthcare reimbursement models, and payer-provider dynamics. • Expertise in claims processing systems and technologies (e.g., EHR, claims adjudication software). • In-depth understanding of healthcare regulations, including HIPAA and CMS guidelines. • EZ-CAP software experience is a bonus. • Prior experience working in managed care/IPA setting.
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