Claims Administration Director leading claims management activities and ensuring quality control. Responsible for operations and collaboration with various departments to achieve strategic goals.
Responsibilities
Provides leadership and direction for the Claims Administration team
Ensures claims are processed for payment accurately and timely
Identifies and resolves operational issues using documented processes
Serves as expert in provider billing, reimbursement, and encounter reconciliation
Collaborates with Vaya business teams to support operational improvement
Reviews and provides leadership for handling unusual claims or eligibility issues
Monitors claims activities and ensures compliance with policies
Requirements
Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, Human Services or related field required
10 years of claims processing experience; supervisory role with increased responsibilities over time
Extensive knowledge of claims management, Medicaid, and State funding rules and regulations, third-party payer, and coordination of benefits
Knowledge of a capitated managed care environment
Strong focus on the people side of change
Proficiency in Microsoft products to include Excel and Outlook
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