Sr. Manager of Claims Operations

Position: Sr. Manager of Claims Operations

Job Type: Full Time 

Location: Remote - Remote (Must Live in Colorado) 

Compensation: $70,000-85,000 Annual Salary + Incentives 

 

About The Role 

We are seeking a highly skilled Senior Manager of Claims Operations to oversee the daily billing and claims management operations. This role is ideal for someone who thrives in a data-driven, hands-on managerial position and is committed to driving efficiency and accuracy in billing and collections processes. The successful candidate will have a strong process orientation and drive to win on behalf of the organization and patients.

Billing & Collections:

• Oversee the entire billing cycle, ensuring claims are processed timely by following established protocols, attention to key detail and ensuring effective prioritization and escalation
• Understand requirements and build relationships with insurance payors to meet needs and optimize timely, friction free payment
• Process insurance claims for private and employer insurance reimbursement
• Process and follow up on payor denials, consulting with the client and/or family as needed
• Utilize data to identify and address root causes of payor denials
• Manage and intervene as needed for complex claim denials
• Manage and hold team accountable to specific performance metrics
• Post payments in a timely manner

Quality & Compliance:

• Complete necessary documentation, timely entries into the records, and maintain compliance with overall documentation
• Assist in preparing documents for annual billing audits
• Ensure that all financial records meet audit and compliance standards and help maintain adherence to regulatory and payor requirements

Team Leadership & Training:

• Recruit team members where possible with Mental Health / Substance Abuse billing & coding experience
• Record attendance in billing software for services performed to submit claims
• Onboard new billing staff and ensuring they receive thorough training on procedures and performance expectation
• Provide ongoing support to the team and help them stay up to date with new billing functions

Collaboration & Communication:

• Collaborate with other departments, including working closely with Billing Operations, Benefits Verification, and Director of Revenue Operations to reconcile billing reports
• Responsible for providing regular billing reports, including weekly and monthly summaries of billing, accrual, and denial totals to the Director of Revenue Operations and other key stakeholders
• Assist in reconciling billing data with the financial subledger to ensure accuracy
• Participate on committees and in professional meetings and staffing as necessary for the functions of the program
• Provides supportive leadership for community meetings and selected off-campus activities
• Participates in marketing activities
• Continuous Process Improvement:
• Play a key role in identifying opportunities to improve efficiency in billing processes
•  Make recommendations for streamlining operations and contribute to ongoing improvements to better support the billing team
• Participates in the facility-wide Performance Improvement Program
• Other duties as assigned

 

Qualifications

Education Requirements:

• High school diploma/GED required
• Bachelor’s degree in a related field preferred or equivalent experience
• Coding certificate or associate’s degree in business administration or health care administration preferred

Experience Requirements:

• 4+ years of experience in healthcare billings and claims
• 2+ years of experience in leading a team
• Experience working with out of network and other complex claims adjudication
• Must have valid driver's license
• Work closely with all members of treatment team to assure positive working relationships
• Must consistently demonstrate the ability to establish and maintain good public relations with families, referral agencies, and other community resources
• Must have the ability to express ideas clearly, concisely, convincingly, and effectively when addressing an audience
• Consistently exercise good judgment and adequate emotional stability in evaluating situations and making decisions despite the pressures of deadlines or the occurrence of unexpected stressful events

Other Requirements:

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