Experience
10 to 12 years Client Locations
ChennaiSkills Required
Claims Manager (Adjudication)
Job Description
Job Title: Claims Manager (Adjudication)
Experience: 10 to 12 years experience in Claims Adjudication.
Budget: 8 LPA to 12 LPA (Not constrain for Right candidate)
Location: Chennai
Immediate Joiners only
Functions & Job Responsibilities
· Hires, trains and supervises staff; conducts performance reviews and completes corrective actions as applicable.
· Monitors staff’s performance and ensures adherence to policy/procedures and the highest level of customer service.
· Coordinates daily claims operations including; monitoring inventory priorities, adherence to Medicare processing guidelines, Claims System workflow queues, and key performance indicators (KPIs) and metrics, compliance of regulatory and quality standards including but not limited to Centers for Medicare and Medicaid Services (CMS) requirements.
· Conducts presentations or designates staff to present at provider relation workshops related to claims submission, new claims programs being implemented and current billing guidelines.
· Develops, implements, updates, and reviews remediates and report’s findings; forwards impact and remediation plans to upper management for processing desktops, job aids and data base reporting tools for new health plan programs and claims system configuration for adjudication updates.
· Ensures processing turn-around times for claims processing are met and processed as follows; Medicare claim payments are completed as follows; 95% in 30 days (clean claims) and 60 days (unclean) and 95% payment accuracy.
· Serves as the subject matter expert, represents claims at interdepartmental meetings and provides back up support to claim processing as needed. Schedules regular monthly unit meetings to go over any changes to programs or training issues; holds one-on-one meetings with staff to address their monthly progress on success factors (production, quality, etc.).
· Communicates job expectations and improvements as needed.
· Analyzes production goals, trends and recommends work performance standards modification as needed.
· Completes other projects and duties as assigned.