What are the responsibilities and job description for the Director of Claims Operations Healthcare position at NTT DATA?
Job Description
NTT Data is assisting our Healthcare client in their recruiting efforts for this role. This is not a position with NTT Data.
Job Title: Director of Operations (Healthcare)
Start Date: Last week on November
Onsite
PayRate; 120k-140k- Depending on experience
Job Summary:
The Claims Director oversees the team responsible for processing the billing for healthcare services. This position will be responsible for producing quality outcomes and key performance metrics that meet and exceed regulatory compliance, industry best practice and audit requirements for all areas of responsibility. The Director will also participate in the development of relationships with stakeholders to ensure timely, efficient and effective workflows.
Duties and Responsibilities
Competencies:
Required Knowledge, Skills and Abilities
NTT Data is assisting our Healthcare client in their recruiting efforts for this role. This is not a position with NTT Data.
Job Title: Director of Operations (Healthcare)
Start Date: Last week on November
Onsite
PayRate; 120k-140k- Depending on experience
Job Summary:
The Claims Director oversees the team responsible for processing the billing for healthcare services. This position will be responsible for producing quality outcomes and key performance metrics that meet and exceed regulatory compliance, industry best practice and audit requirements for all areas of responsibility. The Director will also participate in the development of relationships with stakeholders to ensure timely, efficient and effective workflows.
Duties and Responsibilities
- Manage all activities associated with claims operations, ensuring continuous improvement of processes, systems and communications
- Provide leadership for strategic planning, financial management, service development and special projects
- Oversee and coordinate cross-functionally the resolution of complex issues and concerns
- Lead claims management and staff to drive talent and culture initiatives to maintain a high-performing team
- Provide hiring, promotion, and disciplinary recommendations, as well as performance evaluation and feedback for direct and indirect reports
- Maintain an orderly workflow according to priorities and determined metrics
- Draft, implement and execute policies and procedures to facilitate a quality-focused claims processing experience, that reflects industry best practice
- Implement and improve on systems to capture and report on outcome metrics; audit processes to assist with error detection and correction
- Determine and evaluate service levels and requirements for the department
- Develop and implement training and quality assurance programs for new hires and experienced employees
- Liaise with other departments to improve operational cross-functionality Identify and recommend or acquire updates and expansions
Competencies:
Required Knowledge, Skills and Abilities
- Bachelor's degree in field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience
6 years of experience in a claims management role where HIPAA and HITECH standards are utilized; experience with TPA organization desired as well as knowledge of other healthcare operations such as system configuration, client/member/provider service, Quality/Audit
- 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; perform (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 promptly, 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
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