Located in tigard, OR
Job Full Description
We are looking for an experienced and detail-oriented Medical Claims Manager to join our team. In this role, you will oversee the medical claims process, manage a team of claims adjusters, and ensure that all claims are processed accurately and efficiently. You will also work closely with healthcare providers, insurance companies, and policyholders to resolve any issues and improve claims processing. If you have strong leadership skills, an in-depth understanding of medical billing, and a passion for ensuring high-quality service, we want to hear from you!
Duties:
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Supervise and manage a team of medical claims adjusters to ensure timely and accurate claims processing
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Review and process complex medical claims, ensuring they are in compliance with insurance policies and regulatory requirements
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Oversee the resolution of claims disputes and work with healthcare providers, insurance companies, and patients to address issues
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Ensure claims are processed within the required timeframes, adhering to industry standards and company guidelines
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Develop and implement policies and procedures for claims processing and quality assurance
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Analyze claims data and identify trends or areas for improvement in the claims process
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Provide training and guidance to the claims team to enhance performance and ensure proper understanding of medical codes and insurance guidelines
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Stay updated on changes in insurance regulations, medical billing codes, and other industry standards
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Generate regular reports on claims metrics, including approval rates, denial rates, and team performance
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Coordinate with other departments, such as billing and customer service, to ensure efficient claims handling
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Handle escalated claims issues and work to resolve customer concerns or complaints
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Ensure compliance with HIPAA and other privacy regulations regarding medical claims information
Preferred Skills:
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Proven experience as a Medical Claims Manager or in a related medical claims or insurance role
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Strong knowledge of medical billing codes (CPT, ICD-10, HCPCS) and insurance policies
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Experience managing a team and providing leadership and training
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Strong analytical and problem-solving skills
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Ability to handle complex claims and make decisions based on insurance guidelines and regulations
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Excellent communication skills, both written and verbal
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Detail-oriented with excellent organizational skills
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Ability to work independently and manage multiple priorities in a fast-paced environment
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Proficiency in claims management software and Microsoft Office Suite (Excel, Word)
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Familiarity with healthcare regulations, including HIPAA compliance
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A degree in Healthcare Administration, Insurance, or a related field is preferred
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Relevant certifications (e.g., Certified Professional Coder, Certified Claims Professional) are a plus
Benefits:
Apply online or at our office:
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Take the first step toward your success. Apply online or Visit us today!
www.Expresspros.com/TigardOR
We are located at:
10115 SW Nimbus Ave. #500
Tigard, OR 97223
503-624-2001
Need more information about this job?
Contact our Staffing Consultants at 503-624-2001, or by email at Jobs.TigardOR@expresspros.com.
Tigard, OR
1932
10115 Southwest Nimbus Avenue
Suite 500
Tigard, OR 97223
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