Manager, Claims Payable

Description

Job Summary:
Manage the Claims Payable staff and all functions responsible in the Claims Payable Department. Ensure all Claims Payable functions, including check runs, check adjustments, refund settlement adjustments, and provider overpayment collections are completed according to policies and procedures and in a timely and accurate manner. Oversee the TPA Claims Payable staff, processes and issues. Develop Claims Payable staff and monitor the workflow of the department. Report to the Sr. Director, Finance and work closely with the General Accounting department to ensure all reporting and reconciliation needs are being met. This also offers a hybrid work environment and is 60% in office and 40% work from home. 

Responsibilities:

• Responsible for the regular and ongoing review of processes, policies and procedures to make certain processes are being completed accordingly and identify areas of weaknesses and opportunities to improve efficiencies.
• Investigate and follow up on escalated provider issues requested from the service areas and upon direct provider requests. Make certain staff is following up on cutlogs assigned to them in a timely manner and handle any of the more difficult provider issues.
• Maintain quality and production standards outlined for the Claims Payable Department.
• Organize and direct workflow.
• Maintain excellent working relationship with all departments.
• Oversee the implementation of new products, services and systems. Includes changes required as part of the provisions for the Affordable Care Act and any associated Healthcare Reform changes.
• Responsible for the development of Claims Payable Staff and cross train staff members on functions of the department. Handle the performance management process for Claims Payable staff
• Oversight of the TPA Payable process and issues. Ensures adherence to standards set forth and is the liaison related to any TPA related issues.
• Responsible for reviewing and approving the work of Claims Payable staff to ensure accuracy.
• Manage daily functions of Claims Payable department including: payable processes, 1099 filings, check/refund adjustment inventory, provider issues (cutlogs), provider overpayment collection and reporting requirements.
• Oversee SOX requirements for Claims Payable Department. This includes quarterly review of SOX narratives and completion of testing according to deadlines.
• Conduct employment interviews.
• Train and supervise personnel, including preparation and presentation of employee evaluations
• Recommends and implements system enhancements for Claims Payable Systems and oversees testing of new processes and enhancements.
• Assist in the reconciliation and reporting of processes, which tie closely to General Accounting. This includes ASO billing and reconciliation, Bank Reconciliations, Journal Entries, HRA reporting and Provider AR.
• Responsible for budgetary requirements and monitoring for Claims Payable area.

Qualifications

• Bachelor's degree or equivalent required.
• Minimum of six years of related work experience required.
• Minimum of one year managerial or supervisory experience required.
• Working knowledge of medical terminology and an understanding of accounting and financial reporting.
• Knowledge and expert understanding of all products and services of UPMCHP insurance offerings.Superior planning, communication, documentation, organizational, analytical, and problem solving abilities.
• Excellent leadership skills and the ability effectively manage and develop staff.
• Able to demonstrate organizational, interpersonal, and communication skills.
• Develop production and quality standards and monitor workflow to ensure ability to maintain standards set forth.
• Advanced computer skills with strong knowledge in Excel, Access, Word, and other financial/operational software packages.
• Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences.
• Ability to effectively lead change and work in a fast-paced environment a must.
• Demonstrate a high degree of professionalism, enthusiasm, and initiative on a daily basis.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary : $31 - $52