Jewish Family and Children’s Service’s (JFCS) values each and every talented applicant, regardless of religious beliefs, race, age, origin, gender, sexual orientation, or cultural background. JFCS places a high value on inclusion and diversity, whether that applies to our employees or the nearly 40,000 clients receiving our services throughout the Valley.
Director of Claims: This role directs the claims functions of JFCS and is accountable for business results through cost-effective and timely resolution of claims. In conjunction with Senior Management, the Claims Director works within assigned limits of the highest authority on assignments requiring a high degree of technical complexity and coordination.
Duties include:
- Utilizing revenue cycle management best practices and compliant processes, manages claims submission, payment reporting, and claims collections to contribute to organizational sustained profitability.
- Manages the Claims Department personnel and ancillary expenditures to maintain budgetary targets and control expenses.
- Creates policies and procedures to prevent fraud, diminish incorrect billings and assure ethical claims administration outcomes.
- Devises training programs to engage staff in processing claims correctly avoiding excessive rebilling of claims, claims denials and aged claims.
- Develops strategies and collaborates with senior management to reconcile claims timely, review associate documentation and prevent claims denials.
- Maintains currency and possesses full knowledge of billing requirements for all Payers, State Agencies and Federal programs and changes of existing practices and methods and keeps the CFO/COO updated on all impactful guidelines.
- Manages, instructs, and directs staff toward claims administration objectives that assure productivity, profitability and task efficiency.
- Effectively coordinates with Client Eligibility to manage client/insurance coverage related claims.
- Audits and conducts file reviews to ensure staff are compliant with insurance laws, claims and policy guidelines.
- Directs the work of claims staff to ensure deadlines and timelines are met and designated goals and objectives achieved.
- Ensures reconciliation of cash received to cash posted is completed on a monthly basis.
- Manages third party claims.
- Performs other tasks as assigned.
Qualifications:
- Ten years of experience in directing claims administration preferably in a non-profit or an equivalent of private/public sector experience.
- Adeptness utilizing Next Gen, Excel and other data analytical technology.
- Ability to speak and write with clarity.
- Bachelor’s degree or an equivalent amount of experience and training in financial and data analytics, or behavioral claims administration.
Benefits of Working with JFCS:
- Bonus Programs for both full-time and part-time employees.
- FREE Primary HealthCare to all employees and every member of their household, regardless of relationship. This includes virtual doctor's visits, physicals, lab tests, x-rays, vaccinations, prescriptions, and telehealth.
- Generous Employee Referral Bonuses for both the new-hire and the referring employee.
- Bilingual (Spanish-English) Pay Differential.
- Flexible Scheduling and Telehealth Flexibility for many positions.
- 401(k) Retirement Plan, with Company Match.
- We offer tuition and clinical license reimbursement.
- Numerous professional development and career growth opportunities.
- Generous paid time off / sick time allocations.
- Comprehensive Employee Benefits package, including medical, vision, dental, & more.
- Wellness Coaching.
- Employee Assistance Program.
- Eligibility for Loan Forgiveness Programs in many positions.