Director of Claims
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POST DATE 8/26/2016
END DATE 12/19/2016
Monterey Park, CA
JOB DESCRIPTIONDIRECTOR OF CLAIMS needed for a DIRECT HIRE opportunity with Yoh's MANAGED CARE client located in MONTEREY PARK, CA.
The Director of Claims Operations is accountable for the overall operations and performance of Claims Department. Responsible for consistent compliance in all aspect of claims operations. The Director collaborates with other stakeholders in developing process improvements as they relate to claims payment accuracy and timeliness.
TOP SKILLS YOU SHOULD POSSESS:
* Director of Claims experience in an IPA or Managed Care setting required
* Bachelors Degree in related field; Masters Degree a plus
* Minimum 10 years management experience
* Project implementation experience
* Ability to effectively communicate with multiple levels of personnel both verbal and written
WHAT YOU'LL BE DOING:
* Develops processes and/or systems as they relate to the department and company's initiatives/programs and/or regulatory changes/requirements
* Interacts with other departments to define project parameters such as claim auto adjudication improvements and regulatory reportrequirements
* Develops and implements policies and procedures as they relate to claims operations
* Analyzes, designs and manages project workflow processes, timeframes and resources
* Stays abreast on all regulatory and/or contractual changes, communicates changes to appropriate staff and department
* Develops reports as required by Senior Management and regulatory agencies
WHAT YOU NEED TO BRING TO THE TABLE:
* Minimum 10 years experience working in a managed care environment, preferably in a Health Maintenance Organization and claims operations
* Knowledge of different regulatory requirements such as Title 22, Title 28 California Code of Regulations Sections 1300.71, 1300.71.38, LA Care, Title 42 Code of Federal Regulations (CFR) Part 422 and other CMS Part C claims standards or contractual provisions on claims processing
* Expertise on medical claims systems platforms, preferably Power MHC
* Detail oriented and ability to multi-task and able to meet frequently changing work demands
WHAT'S IN IT FOR YOU
* Committed to providing health care that is medically excellent, ethically driven and delivered in a patient-centered environment that recognizes the positive relationship between health education, a culture of wellness, an emphasis on prevention and a cost-effective delivery of care
* Company is committed to basic moral and ethical values driven by integrity, honesty and respect for all