Job Description

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

The Claims Director oversees the daily operations of the Claims Department.
Assure department efficiency and effectiveness:
* Achieve financial objectives
* Communicate job expectations to staff
* Plan, assign, monitor, and appraise employee’s job results
* Develop, implement, and enforce policies and procedures
* Maintain, train, orient, mentor and evaluate staff
* Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Health Choice employee


Oversee operations of the claims department and resolution services:
* Monitor claims statistics, production levels and payment and procedural accuracy
* Ensure Health Choice policies comply with AHCCCS and other payer policies
* Evaluate departmental needs and implement necessary controls and interfaces
* Counsel staff in regards to Health Choice, AHCCCS, Medicare and CMS claims payment guidelines.


Identify and implement cost containment practices:
* Manage annual operating budget for the claims department
* Monitor and adjust monthly departmental budget and cost
* Monitor departmental goals and time sheets for overtime usage
* Review actual monthly expenditures and research variance


Interface with HCA’s IS department and identify and participate in development of system modifications:
* Request modification/enhancements
* Test completed modifications
* Train staff in use of modifications


Organize efforts to reduce overpayments and recoupments:
* Maximize reimbursements by monitoring internal audit, adjustment and referral statistics
* Ensure that staff is appropriately educated on correct adjudication of payment


Continue professional growth and development to maintain high quality work:
* Attend seminars and meeting addressing changes or updates in practices
* Take necessary steps to stay informed of updates from governing agencies



Qualifications

Preferred Qualifications:

Bachelors degree in Health Services Administration or related science or administrative field

At least five (5) years experience in medical claims management, preferably in a managed care environment

At least three (3) years supervisory experience

At least three (3) years in a large healthcare organization

 

Knowledge and Skills:

CPT, HCPCS, ASA and ICD-10 coding schemes

Claims billing - 1500s, UB92s, and dental

Managed health plan functions and responsibilities

Plan benefits

Excel and Word proficiency

Proven leadership skills

Strong organizational skills

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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