Manager, Claims - Denver Health Medical Plan (Must Live in Colorado)
About The Position
We are recruiting for a mission-driven Manager, Claims - Denver Health Medical Plan (Must Live in Colorado) to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration Must Live in Colorado Hybrid role with an in-office requirement of 3 days per week in Denver, Colorado Job Summary Maintains supervision of the day to day claims processing function for the Denver Health Medical Plan. Trains claims business analysts to ensure accurate processing of claims. Educates regarding subrogation and coordination of benefits. Reviews claims adjudication for timeliness and accuracy of payment. Educates claims business analysts regarding contract terms. Interfaces with other personnel within the Managed Care Division to assist with extraction of accurate claim information for reporting purposes. Interfaces with Managed Care Information Systems regarding system changes and data extraction.
Requirements
- Bachelor's degree required
- Five years of health care claims experience required
- Two years of lead or supervisory experience required
- Fluent understanding of HCPC codes, UB 04 forms, HCFA 1500 forms, RBRVS fee schedules, and other common claim coding conventions.
- Understanding of NAIC coordination of benefit rules.
- Excellent verbal and written communication skills.
- Demonstration of good supervisory skills.
- Knowledge of general report writing.
- Ability to work independently and collaboratively, generate creative ideas for interventions with other internal and external team members to ensure timelines are met
- Proficient in Microsoft Suite
Responsibilities
- Oversees the day-to-day operations within the DHMP Claims Department and the vendor Claims Department.
- Ensures optimal performance in claims quality, claims financial accuracy, and compliance with State and Federal Regulations.
- Manages claims analyst to resolve claims issues related to authorization issues, provider issues, claim edits, and claim audits.
- Manages proactive and retrospective claims review that are done on a continual basis to ensure accuracy and to identify system and/or processing issues.
- Manages claim recoupment efforts.
- Assists with system upgrade efforts.
- Recommends, reviews and modifies all necessary policies and procedures within the department.
- Prioritize work volumes on a daily basis.
- Drives change initiatives to address future-oriented business needs.
Benefits
- Generous paid time off
- Fully paid parental leave
- Exceptional retirement contributions
- Comprehensive health coverage
- Nationally recognized well-being programs
- Tuition assistance
- Career advancement pathways
- Professional development
- Meaningful financial advantages
- Loan forgiveness eligibility
- Employer contributions
- Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
- 100% paid parental leave up to 6 weeks
- Immediate eligibility for retirement plans with employer contribution up to 9.5%
- Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
- Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
- Free RTD EcoPass (public transportation)
- Childcare discount programs & exclusive perks on large brands, travel, and more
- Tuition reimbursement & assistance
- Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
- Professional clinical advancement program & shared governance
- Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
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What This Job Offers
Job Type
Full-time
Career Level
Manager
