Manager Claims Admin - Revenue Cycle Claims Processing - Sharp Corporate - Day Shift - Full Time

Sharp HealthCare • San Diego, CA

6d • Onsite

About The Position

This position manages the claims units for Sharp Managed Care Contracts. This includes but is not limited to claims for Sharp Rees-Stealy, Sharp Community Medical Group, and claims for EOHD, Clinical Trials, and Transplant services paid by Sharp HealthCare. This position is responsible for prompt, accurate, and efficient processing of claims.

Requirements

• 3 years' experience in the HMO industry to include claims, customer service, and/or health insurance management.
• 2 years leadership experience.
• Knowledge of health insurance or HMO operations with emphasis on claims.
• Excellent organizational and interpersonal skills.
• Ability to work effectively as a member of a creative management team.
• Adept at being an initiator of positive change to support the Mission, Values, and Goals of Sharp Healthcare.
• Excellent analytical skills and understanding of data base management.
• Knowledge of claims coding system, claims auditing techniques, and claim software functionalities.

Nice To Haves

• Experience with EPIC Tapestry.

Responsibilities

• Display professionalism and teamwork in promoting the Mission, Goals, and Objectives of Sharp Healthcare.
• Recruit, hire, motivates staff to perform at a level that consistently meets expectations.
• Develop, train, counsel staff, and conduct performance appraisals.
• Manage the daily operations of the claims department maintaining claim turnaround times at 95% processed within four weeks, 95% of the time, and maintaining accuracy rates of 95% procedural and 98% financial.
• Develop reporting and follow through mechanisms to document departmental efficiency and productivity.
• Responsible for the development and implementation of continuous quality improvement and measurement of claims unit effectiveness.
• Coordinate continuing staff training and establish quality and productivity standards to be reported monthly.
• Provide input into claims policy and procedure manuals.
• Effectively communicate departmental policies to staff and other affected areas.
• Participates in the development and implementation of improvements in software functionality, workflow and system integration.
• Interface with Health Plans, Providers, Members, and Medical Groups to resolve issues in a professional manner that maintains consistently positive relationships.
• Demonstrate a positive, professional and contributory posture in all matters requiring interface with customers, both internal and external.
• Demonstrate safe work practices by identifying and reporting potential safety hazards to appropriate personnel, including but not limited to the following: Assuring staff’s appropriate chair height, keyboard and screen placement, securing of electrical wiring, use of proper body mechanics, etc.
• Attend annual Safety Fair.

Benefits

• Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree