Claims, Manager

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

The Claims Manager will lead in managing the billing process for medical services, coordinate with external partners to ensure accurate claims processing, and improve efficiency through data analysis, which will contribute to providing effective healthcare services to our patients.

• Managing, directing, monitoring, and providing leadership to direct reports.
• Manage activities, workflow, and performance within the department to account objectives, and service levels.
• Maintains knowledge of Medicaid and Medicare policies, and procedures pertinent to department or Agency activities.
• Identifies processing or administrative policies and procedures needed or recommend changes as required.
• Manage Service Level Agreements (SLAs), for a claims processing areas which include, medical bill intake, Authorizations, and Provider Enrollment services.
• Maintains close liaison with other departments on matters pertaining to areas of responsibility.
• Establish and monitor production goals, communicating results to the team, and identifying and managing underperformance as needed.
• Coordinates claim and recovery activities with other departments as necessary.
• Responsible for resolution of escalated issues in the day-to-day operations of the department.
• Projects and trends future workload volumes and staffing requirements within the department.
• Responsible for the selection, training, counseling, and salary administration of direct subordinates. Recognizes and rewards assigned employee.
• Responsible for forming developmental plans for employees and performing all reviews.
• Review and evaluate all Claims Operations functions routinely, ensuring uniform and documented processes and management strategies are in place.
• Develop succession plans for all areas of responsibility.
• Must comply with corporate compliance programs and be able to maintain confidentiality.
• Must comply with and implement corporate information security policies, standards, and guidelines relative to access control.
• Collaborate with the Operations Manager to develop and maintain staff schedules, ensuring contract requirements are met.
• Conduct training sessions for team members.
• Perform regular team member reviews.
• Assist in setting and monitoring production goals, communicating results to the team, and informing the GM of any underperformance.
• Process claims as necessary to support production goals.
• Review and evaluate all Claims Operations functions, ensuring uniform and documented processes and management strategies are in place
• Provide guidance to Claims Team members on day-to-day operations and recommend changes in strategies, plans, and policies
• Coordinate all Claims units to ensure the most current versions of the claims system and supporting systems are in use
• Oversee claim production, ensuring the company meets both quantity and quality standards
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications/Experience:

Either:

• BS/BA degre
• Five (5) years in project/program management, enterprise account level management, or other similar customer facing role consulting on or delivering technical products or services related to medical bill processing or similar environment.
• Three (3) years of that experience in a project/program management leadership role, consulting on or delivering technical products or services related to medical bill processing or similar environment (may overlap with other experience)
• Proven experience running or coordinating projects or programs which include planning work, tracking progress, managing projects, or overseeing accounts in a healthcare-related or billing-related environment.
• Proven experience running or coordinating projects or programs which include planning work, tracking progress, managing projects, or overseeing accounts in a healthcare-related or billing-related environment.
• Must be willing and able to pass a Federal Background Check

OR:

• A High School or GED equivalent diploma:
• Eight (8) years in project/program management, enterprise account level management, or other similar customer facing role consulting on or delivering technical products or services related to medical bill processing or similar environment. Five (5) years of that experience in a project/program management leadership role, consulting on or delivering technical products or services related to medical bill processing or similar environment (may overlap with other experience)
• Proven experience running or coordinating projects or programs which include planning work, tracking progress, managing projects, or overseeing accounts in a healthcare-related or billing-related environment.
• Must be willing and able to pass a Federal Background Check

This is a hybrid role that requires working onsite at our Tallahassee FL office as needed.

Preferred Qualifications/Experience:

• A Project Management Professional (PMP) Certification is desired

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."