Complex Claims Processing Manager
- Franklin, TN
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.