Claims Manager

NaphCare•Birmingham, AL

11d•Onsite

About The Position

NaphCare has an excellent opportunity for a Claims Manager to join our Corporate Office in Birmingham, AL. This position will be under our Bureau of Prisons Department. This position is on-site at our offfice in Birmingham. NaphCare is a family owned, medical technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 36 years. Come join our team of over 7000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do.

Requirements

Associate's degree required
3+ years supervisory/managerial experience in medical claims adjudication
5+ years of medical claims processing
Knowledge of medical terminology, ICD9, HCPCS and CPT coding, and an ability to understand medical records.
Strong leadership and training skills
Strong follow-up skills
Proficiency in Microsoft Office Suite and strong written and verbal communication skills required.

Nice To Haves

Medicare/Medicaid claims processing experience preferred
Knowledge of Medicare guidelines and payment methodologies

Responsibilities

Analyze reports and review internal audits to ensure benchmarks are met.
Handle escalations with Claims team members, clients, and providers to ensure a resolution is achieved.
Appropriately communicate information both verbally and in writing to clients, team members, and supervisors.
Communicate with other departments as needed to ensure claims are processed accurately and timely.
Assist with training team members on client specific processes and payment methodologies.
Delegate tasks to the team appropriately and provide support to the team members.
Utilize medical terminology knowledge to review claims, medical records, and authorization scenarios.
Exhibit a high comfort level in working with large volumes of data.
Demonstrate a strong attention to detail and a commitment to customer service throughout the claims process.
Work closely with the Director of Claims to ensure claims processes and systems are operating as expected.
Additional duties and specific projects as assigned.