Top 6 Healthcare compliance manager Jobs in Phoenix Az

Claims Oversight & Compliance Manager
Arizona Priority Care —Chandler, AZ
- $100,000 - $110,000 a year
- Full-time
- Hybrid work
- Microsoft Excel
- 5 years
- Office
Compliance Manager
State of Arizona —Phoenix, AZ
- $70,634.30 a year
- 12 hour shift
- Psychiatry
- Mid-level
- Master's degree
- Wellness program
- Paid parental leave
Manager, Compliance and Regulatory Affairs
Suvida Healthcare —Phoenix, AZ
- Full-time
- Spanish
- 5 years
- HIPAA
- Paid parental leave
- Paid holidays
Quick Apply
Pharmaceutical Content Compliance Manager
Strive Pharmacy —Mesa, AZ
- $120,000 - $140,000 a year
- Full-time
- Remote
- Google Workspace
- Writing skills
- HIPAA
- Health savings account
- Health insurance
3d
Senior Manager, Corporate Compliance - Risk Adjustment
CVS Health —Scottsdale, AZ
- $75,400 - $165,954 a year
- Full-time
- Nursing
- 7 years
- Bachelor's degree
- Health insurance
- Dental insurance

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Provider Compliance Manager (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. If position oversees assessment or reassessment of…
$40.40 an hour
2d

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Claims Oversight & Compliance Manager

Arizona Priority Care -
Chandler, AZ

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Job Details

Full-time
$100,000 - $110,000 a year

Qualifications

Computer operation
Contract management
Staff supervision
Microsoft Excel
Customer relationship building
Medicare
Health insurance policy knowledge
CMS
Regulatory compliance in claims processing
Contract management experience in healthcare
CMS regulatory compliance
Math
Medicare regulations
Data interpretation
Presentation preparation
Centers for Medicare & Medicaid Services (CMS) billing regulations
Productivity software
Medical terminology

Full Job Description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Claims Oversight and Compliance Manager ensures that claims processing aligns with federal and internal regulations. They conduct audits, develop Corrective Action Plan (CAP) responses, manage compliance reporting, health plan audits, and oversight of claims processing.

POSITION DUTIES & RESPONSIBILITES

Data validation and submission of all health plan reports and deliverables
Prepare and present audit packets for health plan audits
Point of contact for health plan inquiries
Interpret and implement timely updates to member denial letters, EOBs, and provider letters
Develop CAP responses and ensure that changes are implemented timely and appropriately
Regularly review claims processing, billing, and coding to identify compliance gaps and risks
Oversight of audit functions for offshore teams
Oversight of all adjustment functions and reporting
Ensures appropriate monitoring of PDR logs, provider inquiries, and call logs for timely completion
Maintains contract rates in EZ Cap for appropriate claims adjudication
Coordinates with Claims Manager regarding audit findings to ensure appropriate education and training is provided to Examiners
Oversight of Audit and Adjustment teams to ensure timely review and adjustment of claims
Coordinates requests for contract updates and system configuration.
Collaborates with various departments to ensure system, documentation, and processes are up to date for appropriate claims adjudication.
Ensure that departmental standards and timelines are met within each unit.
Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
Perform other duties as assigned

EDUCATION, TRAINING AND EXPERIENCE

Bachelor’s degree in healthcare administration or related field or equivalent work experience
Minimum 5+ years in health plan/IPA claims processing, audit, or compliance roles
Minimum 5+ years management experience
Knowledge of Medicare rules, medical terminology, and managed care health plan rules and regulations, CPT, HCPCS, ICD-10, RVS codes
Thorough understanding of claims operations to include payment of claims, interpretation of contracts; communication of benefits and eligibility
Ability to draw upon knowledge and experience to anticipate issues, potential risks, implications, and changes to Medicare
Strong math and analytical skills, including the ability to analyze and organize data
Excellent ability to build and maintain business relationships with providers by providing prompt and accurate service
Strong attention to detail
Proficiency in Microsoft Office products, including Power Point, Word, and Excel
Demonstrated strong organizational, analytical, oral presentation, written communications, decision-making skills and leadership skills
Must be able to work under general guidance of Claims Director with little direct supervision
Strong knowledge of Medicare Billing & Payment Guidelines as well as CMS CCI Edits
Familiar with all regulatory requirements including CMS
Strong attention to detail
EZ-Cap Experience is a plus
Must be able to work independently, exercise judgment and communicate effectively.
Must be able to work on computer systems, accessing multiple files and programs.

*This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period.*

Compensation range: The salary range for this position is: $100,000 – $110,000.

Apply Now

Refine Your Search

healthcare compliance manager jobs in phoenix az

Claims Oversight & Compliance Manager

Compliance Manager

Manager, Compliance and Regulatory Affairs

Pharmaceutical Content Compliance Manager

Senior Manager, Corporate Compliance - Risk Adjustment

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