Complex Claims Processing Manager

Seasoned Recruitment - Franklin, TN

overview
Required skills & experience:

  • 2+ years of complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system.
  • 2 + years of experience in a managed healthcare environment related to claims processing/audit.
  • 2 year(s) knowledge of standard coding and reference materials used in a claim setting, such as CPT4, ICD10, HCPCS, and others.
  • 2 year(s) knowledge of CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations.
  • Proficient in processing/auditing claims for Medicare and Medicaid plans.
  • Strong knowledge of CMS requirements regarding claims processing and various Medicare fee schedules; especially Skilled Nursing Facility and other complex claim processing rules and regulations.


What you need to know:

  • This position will have supervisory responsibilities.
  • Completes regular review of internally established reporting such as high dollar claims and establishes best practice claims payment methodology based on the latest CMS claims payment rules.
  • Opportunity to join a rapidly growing company with top-notch culture
  • Great benefits and generous PTO
  • This position will start off remote, however, you will be expected to work 1-2 days per week in the office once the pandemic has calmed down.




Apply to this job
or