Manager, Claims Payable - Remote

Overview

We are seeking a Manager, Claims Payable to oversee all aspects of claims payments from CMS, including code recognition, compliance, claims processing, and claims payment disbursement. This role ensures the timely and accurate processing of claims in alignment with value-based care payment models. This role manages a team of professionals and works across departments to drive excellence in claims processing functions.

In Short

• Lead and manage the claims payables team, ensuring accurate and efficient claims processing.
• Lead weekly calls with Claims Processing System company to ensure adherence to data setup within the system.
• Facilitate the exchange of CRF and CCLF claim files for optimal data management with Claims Processing System.
• Collaborate with roster management to ensure proper set up of practices within the Claims Processing System.
• Ensure timely and accurate claim payments, aligning with quality and productivity targets.
• Develop strategies to enhance claims processing workflows and streamline operations.
• Collaborate with finance, contracting, and provider relations teams to align claims payment processes with value-based care models.
• Prepare and present reports on claims processing performance, highlighting key metrics and identifying areas for improvement.
• Audit claims processing activities to ensure accuracy, proper reimbursement, and regulatory compliance.
• Stay up to date with industry trends, regulatory changes, and best practices related to value-based care reimbursement models.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field required preferred.
• 5+ years of experience in revenue cycle management, with a demonstrated track record of success in optimizing revenue cycle performance.
• 3+ years of management experience, including leading a team of direct reports.
• Offshore team management preferred.
• Certification in medical coding preferred (e.g. CPC, CPB, or RHIA).
• Strong understanding of CMS claims processes and best practices.
• Experience with ACOs, ACO REACH, MSSP programs.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong leadership and management skills.
• Proficient with Microsoft Office Suite or related software.

Benefits

• Competitive base compensation.
• Annual bonus potential.
• Health benefits effective on start date; 100% coverage for base plan.
• Health & Wellness Program; up to $300 per quarter for your overall well-being.
• 401K plan effective on the first of the month after your start date.
• Unlimited paid