Manager, Intake and Claims, Health Plan

Summary

Position is responsible for managing the personnel and processes for the Claims Intake, Rework, Appeals Processing and the Provider Phone Inquiry team. Primary duties include, but are not limited to: 1. Managing the claims intake paper to electronic claim process in compliance with the State contract 2. Managing claims rework and appeals process and turn-around time in compliance with the State contract 3. Managing call center operations including answering phones, faxes, e-mails and responding to provider and billing office inquiries relating to Claims and Benefits. 4. Perform and/or coordinate claims research related to claim issues 5. Hire, train coach and evaluate performance of direct reports 6. Track and report staff metrics to leadership 7. Establish and maintain departmental policies and procedures 8. Perform audits to monitor efficiency and compliance with policies 9. Professionally communicate and collaborate across all functional areas of the Health Plan.

Education & Experience:

• High School diploma or equivalent Bachelors preferred. Will substitute 10 years experience for Bachelors Degree.
• 3-5 years supervision experience.
• Five years’ experience in a medical claims processing environment.
• Must be extremely detail-oriented, precise, and thorough.
• Extensive knowledge of medical claim processing procedures and guidelines.
• Ability to work independently while providing support to a team environment.
• Extensive knowledge of medical benefits and medical terminology.
• Must have strong organizational skills, problem solving, and decision making skills.
• Strong knowledge of claim adjudication and benefit plan application for Texas Medicaid
• Knowledge of commercial insurance provisions.
• Able to process adjustments as needed.
• Knowledge of Microsoft Office Skills including Word, and Excel.

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer

Additional Information