Lead Manager, Medicare Claims (remote)

Jobgether•Kansas, KS

7h•Remote

About The Position

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Manager, Medicare Claims. In this role, you will oversee end-to-end claims services for provider segments, ensuring we meet our business goals. Your leadership will help establish performance targets and manage the claims processing and financial aspects, while also maintaining compliance. Your collaboration with claims leadership will be vital in aligning with customer needs and fulfilling contractual obligations, ultimately enhancing the experience for all stakeholders involved. Accountabilities Streamline shared processing to reduce management by exception Set operational processes to align with market trends and customer demand Manage accounting and financial reporting functions to ensure compliance with standard practices Participate in projects to enhance claims processing and recovery functions Oversee financial recovery activities including refunds and collections Lead team and staff to optimize work volume and engagement Resolve complex claims appeals by coordinating with stakeholders Collaborate with Audit and Payment Integrity to ensure accuracy and quality Develop tools and techniques for process improvements Serve as the Medicare Claims Subject Matter Expert and primary contact for performance monitoring Represent Claims Operations in monthly calls with CMS and provide updates and expertise Engage with Compliance and regulatory entities, particularly CMS

Requirements

Bachelor's degree or advanced degree in a relevant field
8+ years of experience in a related field, with 10+ years in lieu of degree
Strong analytical skills and ability to manage operations effectively

Nice To Haves

Experience in Medicare and Medicaid or highly regulated environments is a plus
Familiarity with accounting principles and compliance policies
Skills in claims management and resolution

Responsibilities

Streamline shared processing to reduce management by exception
Set operational processes to align with market trends and customer demand
Manage accounting and financial reporting functions to ensure compliance with standard practices
Participate in projects to enhance claims processing and recovery functions
Oversee financial recovery activities including refunds and collections
Lead team and staff to optimize work volume and engagement
Resolve complex claims appeals by coordinating with stakeholders
Collaborate with Audit and Payment Integrity to ensure accuracy and quality
Develop tools and techniques for process improvements
Serve as the Medicare Claims Subject Matter Expert and primary contact for performance monitoring
Represent Claims Operations in monthly calls with CMS and provide updates and expertise
Engage with Compliance and regulatory entities, particularly CMS