Centerwell Senior Primary Care
Healthcare
Manager,ClaimsProcessing
“Manager, Claims Processing at Centerwell Senior Primary Care. Skills: Claims processing, People management, Process improvement, Compliance. Oversee claims adjudication and resolution. Ensure compliance with payer guidelines”
What You'll Achieve.
timely, accurate, and compliant processing; optimize workflows; improve departmental performance; department goals; productivity metrics; accuracy standards; service-level agreements; improve claims processing efficiency; denial rates; turnaround times; cash flow; address root causes; revenue cycle outcomes; payer compliance; operational stability; revenue cycle effectiveness
Industry & Context.
advanced technical knowledge; advanced analysis; independent judgment; analytical skills
What They're Looking For.
Must Have
Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field, or equivalent combination of education and experience, 5 + years of progressive experience in claims processing, billing, or revenue cycle management within home health, DME, home infusion, SNF or related healthcare settings, 2 or more years of people management experience, Comprehensive knowledge of all Microsoft Office applications, including Word, Project and Visio, working knowledge of Medicare, Medicaid, and commercial insurance reimbursement, EDI claims, and healthcare billing systems
Nice to Have
Project Management experience, Six Sigma certification
What You'll Do.
Oversee claims adjudication and resolution
Ensure compliance with payer guidelines
Determine claim payment or denial
Manage escalated claims issues
Manage and develop claims professionals
Coordinate team activities
Identify staffing and training needs
Implement change initiatives
Analyze claims trends
Solve operational and technical problems
Collaborate with other teams
Maintain contact with peer managers
Participate in cross-department meetings
Ensure adherence to regulations
Support internal and external audits
How You'll Work.
Team & Collaboration
Collaborate with Coding, Clinical Operations, Intake, Authorization, Finance, and Compliance teams; Maintain frequent contact with peer managers and senior professionals; Participate in cross-department meetings, briefings, and audits
Communication Scope
Communicates effectively with internal stakeholders and external payer representatives
Process & Methodology
Project Management experience
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