Manage the Health Finance claims function with oversight of end-to-end medical claims processing, adjudication, and payment across multi-state operations.
Ensure compliance with federal regulations and applicable state laws, including CMS, Medicare, HIPAA, and IRS-related requirements.
Oversee EDI claims transactions and maintain accuracy, timeliness, and compliance with payer, clearinghouse, and regulatory standards.
Review and audit claim data for accuracy and handle escalations with strong customer service.
Partner with management to improve cost containment, regulatory compliance, operational excellence, and staff development.
- Minimum of 5 years of experience in medical billing, claims adjudication, and electronic claims processing.
- Working knowledge of medical terminology.
- Strong knowledge of federal healthcare regulations, including CMS guidelines, Medicare Parts A/B/C/D, and HIPAA.
- Understanding of New York state regulations, including NY DFS requirements and EPIC.
- Experience managing claims across multiple states.
- Experience in skilled nursing facility, assisted living, or long-term care environments preferred.
- Advanced expertise with EDI transactions, including 837(I/P/D), 835, 270/271, and 276/277.
- Experience troubleshooting EDI rejections, payer edits, and connectivity issues.
- Experience with state-specific EDI requirements and payer enrollment processes.
- Experience preparing for and supporting state and federal audits.
- Ability to interpret and implement regulatory changes impacting claims processing and reimbursement.
- Bachelor’s degree in healthcare administration, information systems, finance, or a related field, or equivalent experience.
- Certified Professional Coder (CPC), Certified Billing and Coding Specialist (CBCS), or Certified Coding Specialist (CCS) preferred.
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Referral program
- Tuition reimbursement
- Vision insurance
Location
New York, US
Employment Type
Full-time
Experience Level
Manager
Salary Range
$100,000 - $100,000
Remote work allowed
No
Posted
2 weeks ago