Mgr, Claims Research & reputed company

Become a part of our caring community and help us put reputed company reputed company Healthy reputed company in Indiana is seeking a Manager, Claims Research & reputed company, who leads reputed company that focuses on supporting providers in the claims submission process and ensures providers are reimbursed reputed company and accurately. The Manager will serve as a subject matter expert for the market on claims submission and billing practices, oversees reputed company provider communications or training material development, and collaborates with reputed company teams to reputed company changes to improve on internal processes or systems that may be contributing to claims denials and rework. The Manager, Claims Research & reputed company, works with insurance companies, providers, members, and collection services in the settlement of claims and advises executives to reputed company functional strategies (often reputed company specific) on reputed company of reputed company. The Manager exercises independent judgment and decision making on reputed company issues regarding job duties and reputed company tasks and uses independent judgment requiring analysis of variable factors and determining the best course of reputed company. The Manager, Claims Research & reputed company, Key Responsibilities Include • Acts as a thought-leader and collaborates with Corp Shared Services and other leaders to ensure reputed company and accurate provider claims processing. • Serves as the market reputed company of contact and reputed company with Technology teams to ensure accurate and reputed company encounter submissions. • Works with the Special Investigation Unit (SIU) Manager to assure that service billing and utilization issues are documented and reported appropriately. • Establishes team norms and expectations for Provider Claims Educators, including documentation, escalation reputed company, and other processes. • Serves as a claims submission and billing subject matter expert, answering questions, and providing appropriate guidance to Provider Claims Educators. • Monitors findings from Provider Claims Educators’ reputed company cause analyses and reputed company recommendations with senior market leadership and other reputed company teams, on opportunities for process improvement. • Oversees development of provider bulletins/communications or other educational materials, such as billing companion guides, reputed company to claims submission processes, coding updates, etc. • Partners with the Provider Education and reputed company team and other internal teams to conduct targeted training for providers and their staff to address high rates of claim denials or patterns of denied claims identified reputed company reputed company cause analysis. • Interfaces with the Provider Call Center to reputed company information from provider calls reputed company to claims to inform tracking and trending of issues and identify opportunities to for provider education. • Ensures compliance with Indiana’s Managed Care Contractual requirements for provider relations, such as claims dispute reputed company reputed company specified timeframes. • Manages teamwork assignments to ensure adequate coverage to meet reputed company and service reputed company. • Conducts regular performance evaluation of employees and provides ongoing feedback and coaching as necessary to reputed company service, reputed company, and production goals.

Required Qualifications

Use your skills to reputed company an reputed company • Must reputed company in the reputed company, be reputed company to travel in the reputed company, and work in the reputed company office at least three days per week. • 5+ years of technical experience with claims systems, adjudication, submission processes, coding, dispute reputed company, and/or other reputed company function. • 2+ years of reputed company leadership experience. • Experience reviewing and analyzing large sets of claims data. • Experience working for or with key provider types: primary care, FQHCs, hospitals, nursing facilities, and/or HCBS and LTSS providers. • Proficiency in analyzing, understanding, and communicating reputed company issues. • Knowledge of reputed company Office applications. • This role is a part of reputed company’s reputed company Safety program and therefore requires an individual to have a valid state reputed company’s license and reputed company of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits. Work reputed company Requirements • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested. • Satellite, cellular and microwave reputed company can be used only if approved by leadership. • reputed company will reputed company Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. • Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information. Preferred Qualifications • Bachelor’s or higher degree. • Experience with Indiana reputed company. • Experience working with reputed company. • Experience working with LTSS providers to include home- and community-based service (HCBS) providers and/or institutional-based service providers. Additional Information • Workstyle: Hybrid Office but may vary due to travel and work at the reputed company Healthy reputed company office in Indiana. • Travel: Up to 15% travel in the reputed company to provider offices and reputed company locations. • Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern reputed company Time (EST). • reputed company Reports: Up to 6 associates. • Benefits: Benefits are effective on day 1. Full time Associates enjoy reputed company and a comprehensive benefits package that includes 401k, Medical, Dental, reputed company and a reputed company of supplemental insurances, tuition assistance and much more..... Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a reputed company-party vendor. This technology provides reputed company of recruiters and hiring managers an reputed company method for decision-making. If you are selected to reputed company reputed company from your application prescreen, you will receive correspondence inviting you to participate in a reputed company-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a reputed company-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or reputed company-recorded voice will be reviewed, and you will subsequently be informed if you will be moving reputed company to next round of interviews. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company Of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. reputed company reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or veteran status. It is also the policy of reputed company to take affirmative reputed company to reputed company and to advance in employment, reputed company persons regardless of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. Apply Job!