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Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

UCLA Health -
Los Angeles, CA

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Job Details

$95,400 - $208,300 a year

Qualifications

Data visualization software proficiency
HIPAA compliance
Management
Medicare
Managed care
Medical coding software
Managed care organization experience
CMS
Regulatory compliance in claims processing
HIPAA
Medical claims processing software
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Leading team collaboration initiatives
Centers for Medicare & Medicaid Services (CMS) billing regulations
Managing insurance claims teams
Operational excellence initiatives
Productivity software
Business operations
Cross-functional team management
Cross-functional communication

Full Job Description

Description

Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence. The Claims Manager of the Medicare Advantage Plan will:

Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments.
Foster a positive, high-performing team culture focused on quality and exceptional customer service
Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures
Empower the team to navigate challenging scenarios with confidence and consistency

Salary Range: $95,400 - $208,300/annually

Note: This position is flexible-hybrid.

Qualifications

We’re seeking a self-motivated, service-driven leader with:

Required:

Bachelor’s degree in business, health care or a related field and/or equivalent work experience
Five or more years of claims operations experience in a Medicare Advantage or related environment
Three or more years of managing personnel in a claims processing environment
In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.
Knowledge of standard electronic and paper claim formats
Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines
Computer proficiency with Microsoft Office Suite and data visualization tools
Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements
Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)
Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT
Excellent problem identification, resolution, and analytical abilities
Strong communication, interpersonal, and analytical skills
Ability to develop, implement, and evaluate methods/systems to improve efficiency
Ability to lead and facilitate cross-functional workgroups
Proficiency in achieving compliance with regulatory requirements
Ability to travel/attend off-site meetings and conferences

Preferred:

Certified Professional Biller (CPB)
Certified Revenue Cycle Representative (CRCR)

Apply Now

Refine Your Search

Processing Manager jobs

Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

Senior Project Manager (Salesforce / SaaS Implementation)

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