What are the responsibilities and job description for the Claims Manager On Site position at NTT DATA?
Job Description
Claims Manager
Job Summary:
The Claims Manager provides leadership to the team responsible for processing the billing for healthcare services provided to patients. This role will develop and share knowledge of products, benefits, quality requirements and organization procedures. This position ensures claims are allowed or denied based on actual services rendered, legislative requirement and plan agreements. This position will coordinate both internally and externally by providing information and reporting .
Responsibilities :
Skills and Education
Physical Demands:
The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.
Work Environment:
The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.
The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.
Claims Manager
Job Summary:
The Claims Manager provides leadership to the team responsible for processing the billing for healthcare services provided to patients. This role will develop and share knowledge of products, benefits, quality requirements and organization procedures. This position ensures claims are allowed or denied based on actual services rendered, legislative requirement and plan agreements. This position will coordinate both internally and externally by providing information and reporting .
Responsibilities :
- Direct and lead claims processing function for clients ensuring metrics are met or and exceeded; incorporating positive feedback and reward mechanisms
- Hire and manage staffing levels to ensure continuous, quality processing
- Conduct effective resource planning to maximize productivity and turn-around time
- Follow and maintain knowledge of Federal and State regulations; implement changes regarding claims and billing requirements
- Develop, revise and monitor metrics in order to meet division quality, time service and productivity goals
- Monitor inventory levels and aging of claims and assist with workflow assignments.
- Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claim
- Identify and coordinate resources for re-work
- Analyze and identify trends and provide robust reports
Skills and Education
- Bachelor's degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience
- Four years of experience in a supervisory role in a healthcare claims processing role where HIPPAA and HITECH standards are utilized
- Experience with benefit administration platforms such as Javelina preferred
- Knowledge of Federal and State codes related to fiscal operations of healthcare services
- Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10)
- Ability to analyze and interpret problems in data collection, billing, and coding. Determine the source of the problem and apply a solution
- Must be able to calculate and re-calculate claims; performing (sometimes complicated) calculations, applying formulas using multiplication and percentage
- Solid working knowledge of standard computer applications including MS Word, Excel Outlook and PowerPoint
- Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
- Communicate clearly and professionally with internal and external customers
- Work effectively as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
- Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
- Pay close attention to detail in all aspects of the job
- Make decisions using available resources and sound judgment
- Maintain confidentiality and discretion
- Identify and resolve problems in a timely manner, gather and analyzes information skillfully
- Teach, coach, and counsel associates by effectively communicating and providing follow-up.
- Open to other's ideas and exhibits a willingness to try new things.
- Demonstrate accuracy and thoroughness; monitor work to ensure quality.
- Prioritize and plan work activities to use time efficiently.
- Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
- Follows instructions, responds to direction, and solicits feedback to improve.
- Act in such a way to instill trust from management, other associates, as well as customers
Physical Demands:
The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.
- Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
- Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
- Occasional: Lift and/or move up to 10 pounds
- Constant: Regular, predictable attendance is required
- Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
Work Environment:
The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.
The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.
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