• Manager, Claims Customer Service

    Job Locations US-VA-Chesapeake
    Job ID
    2018-5129
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    Manages plans and oversees Claim Customer Service staff to ensure call metrics are routinely met as well as the accurate and timely processing of claims in accordance with the vendor contracts, fee schedule requirements, and established departmental and governmental guidelines.

     

    Responsibilities

    • Responsible for overall effectiveness of the call center to include monitoring the call contact center to ensure calls are handled adequately and timely meeting all required service levels monthly.
    •  Monitor daily claim reconsideration inventory to ensure claims are processed in accordance with timely filing guidelines avoiding any possible payment penalties
    • Assist staff with questions and issues as needed
    • Hire, train, retrain and maintain a qualified staff of exempt and non-exempt employees. This includes coaching, developing skills of staff members and conducting performance evaluations.
    • Perform/analyze and monitor daily, weekly, and monthly auditing of special ancillary projects.
    • Handle difficult and/or escalated provider calls forwarded by Customer Service Representatives
    • Assist in the creation of standard operating procedures and policies and procedures
    • Serves as a departmental contact for other departments on cross-department projects and/or initiatives.
    • Track issues and claim payment discrepancies identified through calls and requests for reconsiderations and ensure issues are shared with senior management, and the Provider Resolutions Manager and work in conjunction to address and/or escalate as necessary to Network Development for provider education to safeguard a continued positive provider - organization relationship.
    • Perform other duties as assigned

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor’s Degree in Business Administration, Health Care or other related field 

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Strong communication skills (both verbal and written)
    • Strong Professional skills
    • Ability to conduct research
    • Knowledge of IDX Claim processing preferred
    • Ability to work independently and effectively with others
    • Strong organizational skills
    • Time management skills
    • Ability to lead and provide direction to others
    • Ability to train and coach
    • Proven analytical skills to show process improvement abilities
    • Problem Resolution Skills
    • Knowledge of CPT-4 coding and ICD-10
    • Knowledge and/or experience implementing Six Sigma processes a plus
    • Knowledge of Medicaid, Medicare and LTSS services preferred

    WORK BACKGROUND/EXPERIENCE

    • Minimum of 3 years of experience in medical/health care environment, preferably claims
    • Minimum of 3 years of customer service experience
    • Minimum of 2 years claim processing experience
    • Knowledge of IDX Claim processing
    • Previous knowledge of various claim types and a working understanding of claims processing

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position. 

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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