Blue Cross NC · 1 week ago
Manager, Medicare Claims
United States
Full-time
Remote
Senior Level, Lead/Staff
$98K/yr - $157K/yr
8+ years expBlue Cross NC is a healthcare organization seeking a Manager for their Medicare Claims department. This role involves overseeing claims services, managing financial reporting, and ensuring compliance while collaborating with various stakeholders to improve claims processing and customer satisfaction.
Financial ServicesHealth InsuranceInsurance
Responsibilities
Streamline shared processing to reduce management by exception
Set operational process to address market trends, BCBSNC capabilities and customer demand
Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards
Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions
Manage financial recovery activities including refunds and collections
Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group
Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims
Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality
Design and develop tools and techniques for improvements. Identifies needed process and procedural changes which will result in improved customer satisfaction
Serve as Medicare Claims Subject Matter Expert and single point of contact for performance monitoring and troubleshooting
Represent Claims Operations on monthly CMS calls with CMS Account manager answering questions, providing status updates and expertise routinely and on demand
Ability to engage as requested by Compliance with regulatory entities, especially CMS on monthly calls and serve as an internal point of contact to prepare feedback on issues under CMS review
Use good judgement in understanding issues and work with compliance to prepare for discussions
Ability to represent claims as a knowledgeable SME
Qualification
Required
Bachelor's degree or advanced degree (where required)
8+ years of experience in related field
In lieu of degree, 10+ years of experience in related field
Preferred
1-2 years of Medicare and Medicaid experience or a highly regulated operational environment – highly preferred
Strong analytical skills with the ability to drive change and manage operations
Ensure risks associated with business activities are effectively identified, measured, monitored and controlled within accordance with compliance policies and procedures
Benefits
Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Tunde Sotunde
President and Chief Executive Officer
Caleb Davies
Medicaid Market CFO - Healthy Blue of NC Medicaid
Recent News
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