The Manager of Medical Claims oversees the daily operations, performance, and strategic direction of the medical claims audit and adjudication function. Key responsibilities include leading a team of Medical Claims Analysts, ensuring claims are processed accurately and compliantly, analyzing denial trends, collaborating with providers and payers, and maintaining adherence to regulations such as Medicare, Medicaid, and HIPAA.
Qualifications include a High School Diploma or GED (Associate’s or Bachelor’s degree preferred), progressive experience in medical claims processing or coding, prior leadership experience, and knowledge of medical terminology, ICD-10, CPT, HCPCS, and insurance reimbursement methodologies.
Additional skills required:
- Leadership and coaching capabilities
- Analytical and decision-making skills
- Effective communication
- Attention to detail and ability to manage multiple priorities
The role requires compliance with all federal, state, and company policies, maintaining confidentiality, and promoting ethical conduct within the team.
- High School Diploma or GED required; Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred
- Progressive experience and certifications in medical claims processing, billing, or coding
- Prior leadership or supervisory experience
- Advanced knowledge of medical terminology, ICD-10, CPT, HCPCS coding
- Understanding of insurance reimbursement methodologies (PPO, HMO, DRG)
- Experience managing workflows, KPIs, and performance metrics in claims or revenue cycle environments
- Proficiency in Microsoft Office, especially Excel, and healthcare claims management systems
Location
Texas, US
Employment Type
Full-time
Experience Level
Manager
Salary Range
$80,000 - $92,000
Remote work allowed
No
Posted
1 month ago