Manager of Transactional Claims

Overview

We are pleased to share an exciting opportunity at Terros Health for a Manager of Transactional Claims in Phoenix, AZ. The successful individual will be highly organized, and strive for excellence in all areas of their job. 

Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. We engage people in whole person health through an integrated care delivery system, thus establishing a medical home for our patients.  In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care.  Our mission is to provide extraordinary care by empowered people through exceptional outcomes.

Recently awarded among Arizona’s Most Admired Companies in 2020 by AZ Big Media

Responsibilities

The Manager of Transactional Claims is accountable for the performance of claims outbound and inbound functions to include the successful generation of claims data from the Enterprise Practice Management System, the electronic and manual billing of claims to payers, and the processing of inbound claims response files from payers; as well as resolving system edits, pends, claims rejections and related claims outbound issues. The Manager of Transactional Claims will oversee staff and be accountable for ensuring claims timeliness, accuracy, and completeness rates are met for the organization. This position reports to the Sr. Director of the Revenue Cycle. 

Full-Time Employed: 40 hours/week

Location: Central Phoenix, AZ (ask us about remote work opportunities) 

Full Benefits Package, including 401K

Generous PTO/Sick Time (4 weeks in year 1)

Leadership

1. Provides hands on leadership, training, mentoring, and work product management to a team of direct reports.2. Encourages an open, communicative, and engaging team environment.3. Ability to formulate, manage, and measure short and long term specific, clear goals to meet key performance indicators and company revenue targets.4. Works collaboratively with Finance, Clinical, Technical, and Operational teams both internally and externally.5. Demonstrates strong communication and presentation skills, including the ability to message effectively and clearly to various staff and leadership levels, both internally and externally.

Claims and Billing

6. Ability to drive strategic direction and goals down to a tactical and executable level.7. Ensures timely and accurate claims billing to all payers.8. Ensures timely and accurate completion of reconciliation of payer claims response files.9. Ensures resolution of claims pends and rejections.10. Tracks, manages, and reports claims productivity.11. Provides data driven deliverables and goals to leadership.12. Works closely with other Revenue Cycle Management and Finance teams, as well as configuration, IT and other business partners to ensure ongoing continuous improvement for claims key performance measures.13. Identifies, recommends, and implements opportunities for improved billing outcomes.

Technical and Analytical14. Ability to effectively navigate an advanced electronic enterprise practice management system.15. Ability to identify and resolve (or partner with the correct department to resolve) practice management system and configuration problems. 16. Ability to gather and utilize data to track goals and performance indicators accurately.

Customer Service and Collaboration17. Partners with various cross functional teams such as provider contracting and enrollment, patient information, utilization review and management, and IT to identify and resolve the root causes of accounts receivable issues. 18. Promotes a service-oriented culture within the organization and assure satisfaction with the quality and amount of support provided for departmental functions, initiatives and projects. 19. Continually seeks opportunities for improving the delivery and support of revenue cycle activities and programs. 20. Assures satisfaction among customer groups with the quality and amount of support provided by monitoring and responding appropriately to outcomes and feedback. 21. As needed, professionally represents Terros Health at external stakeholder meetings and events.

Functional area expertise22. Keeps current on the details of various Commercial, Medicare, and Medicaid billing and claims guidelinesfor all Terros Health payer and service types.23. Ensures compliance with billing and claims guidelines and all other applicable health care regulations and requirements.24. Maintains thorough understanding of work force management and staffing metrics for a claims operationsteam.anuals.

Management1. Interviews, selects and trains employees and/or interns to ensure department objectives are met with low turnover and high retention rates. 2. Manages staff performance through effective, regular and timely feedback, including regular one-on-one meetings and timely completion of performance reviews, and holding employees accountable for meeting deliverables and following Terros Health’s values and policies and procedures. 3. Effectively handles employee complaints in a timely manner.4. Models behavior in alignment with Terros Health’s values that inspires change, demonstrates flexibility and engages employees. 5. Effectively manages and plans department workflow and staffing to meet deliverables with quality outcomes even when the unexpected occurs

Qualifications

• Bachelor’s degree in finance, health care management, information systems, or business administration is preferred, equivalent experience will be considered.
• Minimum of 6 years’ experience working in a claims related job role at a mid to large sized health care provider. Preference for FQHC, Behavioral health, and/or multispecialty provider.
• Minimum 3 years’ experience managing staff within a claims related job role at a mid to large sized health care provider. Preference for FQHC, Behavioral health, and/or multispecialty provider.
• Strong analytical and problem-solving ability, including utilizing data and advanced system tools to capture, trend, track, dashboard, and resolve payment opportunities.
• Demonstrated knowledge of electronic billing systems, files, tools, and protocols.
• Knowledge in and experience with commercial, Medicare, and Medicaid billing requirements, as well as common coding practices, to include comprehensive understanding of electronic data interface (EDI) interfaces and claims transactional processes and sequencing, to include 837, 835, 277, and 999 transactions.
• Must have a valid Arizona Level 1 Fingerprint Clearance card or apply for one within 7 working days of assuming role.
• Must pass a TB Test.
• This role is a non-driving position. This position is performed at one location and does not require travel to various Terros Health centers. May be 18 years of age and with less than two years’ driving experience or no driving experience.

Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

COVID 19 Precautions:

Terros Health remains open for all our patients’ health and wellness needs.  We have put in place many protocols to protect our employees and patients and to create a safe work environment.  Visit our website to learn more: https://www.terroshealth.org/covid-19/ 

At Terros Health we care about the safety of our employees and patients. We now require that all new employees have the COVID 19 vaccine prior to establishing employment. This represents our commitment to stopping the spread of this disease and protecting our community. Thank you for helping to protect our employees and patients.