• Dir Managed Care System&Claims (3927549)

    Company: Memorialcare Health System

    Location: Long Beach, CA

    Date Posted: January 05, 2014

    POSITION SUMMARY The Claims Managed Care Systems Director is accountable for the daily operations and performance of the Claims Department and the Provider Data Maintenance Department PDM With the approval of the VPO the Director develops and initiates systems policies and procedures for claims processing and or related activities engagements Responsible for the activities in claims recoveries on HMO members including Medicaid Medicare Health Families Commercial and Dental assists in monitoring capitation agreements and hospital services rendered The Director is accountable for ensuring all claims are properly and timely paid in accordance with Medi Cal and Medicare regulations as well as contractual and other regulatory provisions With established policies and procedures the Director...

    from MemorialCare Health System