Universal Healthcare MSO, LLC ยท 6 days ago
Claims Manager- Bakersfield 1.2
Bakersfield, CA
Full-time
Onsite
Senior Level
$37/hr - $46.24/hr
5+ years expUniversal Healthcare MSO, LLC is seeking a Claims Manager to lead their claims department. The role involves enhancing productivity, maintaining high-quality standards, and ensuring accuracy in claims processing while managing personnel and workflows.
Hospital & Health Care
Responsibilities
Must effectively manage the claims inventory and provide timely and accurate claims and encounter processing
Overall accountability for ensuring the design and development of claims workflow, policies and procedures as well as make appropriate recommendations that will positively impact operational effectiveness
Responsible for meeting and exceeding operational productivity standards and for ensuring that claims are processed within the timeliness guidelines, while ensuring accuracy and quality
Assure compliance with all contractual and regulatory agencies for all product lines and governing bodies
Ensure proper utilization of human and system resources to achieve stated performance objectives for productivity, quality, data integrity and financial controls within budgetary constraints
Participates in the review and revisions of productivity and quality standards, as needed
Aids senior management in the implementation of new business objectives, EZ-Cap upgrades, and other technical and vendor implementations related to claim processing
Monitors inventory or other reports daily to ensure adequate resources are applied to maintain departmental goals of timeliness and quality
Determine areas within the department requiring concentrated training efforts and plan appropriate actions to address training needs
Participate in organizational planning, including development and revision of action plans and outcomes evaluation as appropriate
Oversee department activities to ensure health plan and regulatory compliance is maintained
Develop and modify policies and procedures, as needed
Responsible for a full range of activities which ensure the operational effectiveness and excellence of the claims department
Participate with other departments and cross-functional work groups on issues related to departmental and organizational efficiencies
Provide support to staff in efforts to maximize efficiencies of staff
Assist in the development of automated solutions to prevent adjudication errors
Develop departmental and individual goals
Assure staff has the information and tolls necessary to perform their functions
Provide Leadership with feedback regarding departmental functions
Interact with internal departments to correct procedural and system problems
Monitor productivity and accuracy of unit staff as they adjudicate, adjust, perform analysis, and research claim projects
Actively participates in the recruiting, hiring and performance management of claims staff
Other related duties as assigned
Qualification
Required
Minimum of 5 years of experience handling all managed care product types in an IPA/group setting
Strong knowledge of professional and institutional claim processing procedures, including COB/TPL/WC
Must be a self-starter who is detailed and result oriented
Strong knowledge of fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, and professional claims
Preferred
Minimum of 5 years of supervisory or management experience preferred
Benefits
Medical
Dental
Vision
Simple IRA Plan
Employer Paid Life Insurance
Employee Assistance Program
Company
Universal Healthcare MSO, LLC
Universal Healthcare MSO is a full service management services organization providing IPA management services to Universal Healthcare IPA, Inc.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Michael Myers
Chief Executive Officer
Jeff Mihal
Chief Financial Officer
Company data provided by crunchbase