Manager of Claims Technical Operations

Colorado Access•Denver, CO

32d•Hybrid

About The Position

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend. What you will do: We are looking for a MANAGER OF CLAIMS TECHNICAL OPERATIONS who can help shape our vision and support our mission. Here is what the position will look like.

Requirements

Experience: Minimum of six years related progressive experience. Project management, program development and program evaluation experience required.
Knowledge, Skills, and Abilities: Knowledge of business administration and healthcare management with strong business acumen skills. Knowledge of SharePoint, managed care and claims payment systems (processing and appeals)required Demonstrates support for the company’s mission, vision and values. Position requires excellent verbal, written and presentation communication skills. Public speaking and professional relationship development skills required. Ability to work independently and propose solutions to issues identified in daily operations. Strong attention to detail with excellent organizational and time management skills. Must have high proficiency in MS office applications especially Excel and Access. May be required to manage multiple priorities and projects with tight deadlines.
Licenses/Certifications: A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Responsibilities

Provides oversight into the execution of claim processing/appeals/encounter/research related business/technical operations.
Conducts routine, actionable claims monitoring.
Develops and monitors dashboards for claims, appeals and encounters to identify volumes, benchmarks, comparative data and continuously improve proactive delivery of information for providers, provider facing teams, and other departments that benefit from early knowledge of changes.
LOB Benefit Review and escalates contract configuration Issues when identified.
Responsible for actionable monitoring and reporting for both internal staff and external vendor.
Manages daily activities with our outsourced claims and audit vendor for compliance with policies, procedures, and performance SLAs.
Participates in Vendor configuration discussions, provides insight and recommendations related to claims configuration.
Maintains external claims editing product and serves as internal SME to build rules. Updates configuration, as necessary.
Attends vendor claims team meetings, tracks issues to resolution, ensures vendor documentation is updated, and claims teams trained on policy or process changes.
Monitors for aging claims, or claims trends identified in research/monitoring that might require claims policy/process changes and monitors all internal claim workbaskets.
Manages the oversight of the encounter monitoring process which includes, but not limited to tracking of submissions, trending, dashboard tracking and monthly reporting to providers and HCPF liaison with Rates Team
Interfaces with the Encounter Data Manager for monthly QA as well as on issues or trends that are seen in monitoring, provides recommendations and solutions.
Serves as a Colorado Access Business Information Owner for claims, encounters and appeals related data.
Serve as a Subject Matter Expert in various committees or meetings as needed.
Represents Sr. Director of Claims Operations and Provider Reimbursement in various meetings as needed.
Stays informed of and aligned with regulatory and compliance requirements, data governance, and company strategy/future alignment of functions and services.
Attends meetings and supports company-wide activities as a Subject Matter Expert on behavioral health, claims, encounters, and appeals for JOC, HCPF, internal/external audits and other meetings as needed.
Supports knowledge transfer of behavioral health with HCPF and Provider facing staff.

Benefits

We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Paid time off
Retirement plan
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).