Mgr Claims Administration Jobs

Summary
We are searching for a Manager, Medical Claims Administration - someone who works well in a fast-paced managed care setting. In this position, you’ll plan, develop and implement Claims processing functions and related processes for the Claims Administration Department. You’ll have key responsibility for the integrity of the claims payment and adjudication process. Additionally, you’ll be responsible for ensuring that claims are processed accurately and timely for reimbursement to the Health Plan Providers and members, in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage.
Think you’ve got what it takes?
Skills & Requirements

• Bachelor's degree HIGHLY PREFERRED
• Required 7 years Health Plan claims administration or related experience
• Required H.S. Diploma or equivalent
• Bachelor's degree with substitute for four (4) of the required years of experience
• Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption.
• 2 years of leadership experience (Preferred)

Job Duties & Responsibilities

• Completes timely performance appraisals for direct reports
• Develop policies and procedures and for a Pediatric HMO which are based on our integrated delivery system goals and objectives and which meet the performance goals and measurements
• Mentor and develop Claims Processing staff toward expansion of job roles in order to meet the continuous challenges and changes of the health care environment, contracts and governmental regulations, including promoting the ability to respond effectively to innovative initiatives
• Plan, develop organize and implement claim processing functions and processes
• Conducts appropriate investigations and follows-up on Provider and Member complaints
• Plan, develop, organize and implement processes to ensure claim adjustments, appeals and correspondence is completed timely and accurately
• Strives to achieve the goal of accreditation with commendation
• Plan, develop, organize and implement processes to ensure timely and accurate claims processing
• Review and implement Texas Department of Insurance regulations pertaining to HMOs
• Review and implement HHSC statutory reporting requirements of Texas Medicaid