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TruHearing · 1 day ago

Senior Manager, Insurance Operations

Draper, UT

Full-time

Onsite

Senior Level

5+ years exp

TruHearing is a mission-based organization focused on improving people's lives through hearing healthcare solutions. The Senior Manager of Insurance Operations will oversee daily operations, develop reports, and lead initiatives aimed at enhancing scalability, growth, and efficiency in insurance processes.

Health CareMedicalMedical Device

Comp. & Benefits

Responsibilities

Engage with payer partners’ leadership teams to resolve complex insurance claim issues and develop systems designed to avoid future issues

End-to-End Revenue Cycle Management Oversight: Ensure accurate and timely benefit verification, claims submission, adjudication, and payment posting and collection. Partner with Accounting Department to resolve outstanding account receivable issues related to health insurance claims and identify processes to minimize such issues

Cash Flow Optimization: Monitor and improve days in accounts receivable, ensuring timely collections and reconciliation

OON Claim Lifecycle Management: Oversee end-to-end processing of out-of-network claims, including benefit verification, pricing, submission, and adjudication. Resolve complex OON claim disputes with payers and patients, including appeals and arbitration processes

Ensure team is accurately and timely verifying member benefits and processing/adjudicating both in-network and out-of-network claims

Work directly with external and internal audit teams, responding to audit requests and ensuring claims adjudication accuracy

Facilitate day-to-day management, and new implementations within the Insurance Operations technology suite (QNTX/Cognizant, Waystar, Trizetto, Availity, Echo, etc.)

Own, document, and keep current insurance processes, procedures, policies, and training materials

Drive innovation and creativity inside of insurance team

Exemplify true subject matter expertise regarding insurance and identify ways to develop other personnel as additional experts

Partner with department leadership to identify objectives and outcomes for the insurance team

Drive for results with measurable improvement in employee retention and satisfaction in collaboration with department leaders and HR leadership; build and cultivate a culture of trust, accountability, and engagement within the insurance team

Successfully lead/participate in client and vendor-facing activities when requested to present needs and solutions related to insurance functions

Build strong relationships inside and outside of the insurance department; respond timely and thoughtfully with all stakeholders to support positive interdepartmental cooperation

Develop forecasting analysis to identify staffing needs and ensure required staffing is in place through partnerships with Workforce Management (WFM), Human Resources (HR), and Finance Departments to ensure interdepartmental cooperation and alignment

Create, implement, and measure the effectiveness of initiatives and related incentive plans through tracking metrics and creating custom reports

Qualification

Revenue Cycle ExpertiseOON Billing ExpertiseRegulatory KnowledgeTeam LeadershipProblem SolvingManaging PeopleProductivityQualityInfluence & PersuasionAccountabilitySubject Matter ExpertisePlanning & OrganizingTeamworkInitiativeDecision Making

Required

Bachelor's degree in a related field. A combination of education and experience may be considered in lieu of a formal education

Five (5+) years of experience in a management role

Revenue Cycle Expertise: Deep understanding of payer reimbursement methodologies, EOB interpretation, Clearing house systems and procedures, and AR management

OON Billing Expertise: Deep understanding of OON claim workflows, usual and customary rate calculations, and payer-specific policies

Regulatory Knowledge: Familiarity with CMS, state insurance regulations, Medicaid, and compliance standards impacting Insurance Operations and RCM

Proven experience with driving efficiency and implementing best practices for high performance