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Salary Estimate: $95908.80 – $143852.80 / year
Learn more about the benefits offered for this job.
Learn more about the benefits offered for this job.
The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.
Introduction
Do you have the career opportunities as a Claims Manager you want with your current employer? We have an exciting opportunity for you to join Pacific Partners Management Services which is part of the nation’s leading provider of healthcare services, HCA Healthcare.
Benefits
HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
Fertility and family building benefits through Progyny
Free counseling services and resources for emotional, physical and financial wellbeing
Family support, including adoption assistance, child and elder care resources and consumer discounts
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
Employee Stock Purchase Plan
Retirement readiness and rollover services and preferred banking partnerships
Education assistance (tuition, student loan, certification support, dependent scholarships)
Colleague recognition program
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
Our teams are a committed, caring group of colleagues. Do you want to work as a Claims Manager where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!
Job Summary and Qualifications
GENERAL SUMMARY OF DUTIES: The Claims Manager’s primary responsibility is to ensure the efficient and effective operation of the department. Coordinates and directs the preparation of documentation for health plan audits and works directly with the auditors to assure that requested information and documentation is available to facilitate a successful audit and compliant results. The position is responsible for obtaining and maintaining in-depth knowledge of the software and claims processing functionality, knowledge of Claims/Operations workflows, including but not limited to, claims adjudication, clinical editing (CES), eligibility maintenance, benefit maintenance and payment processes. Participates in ICE organization workgroups including the Claims Processing group.
DUTIES INCLUDE BUT NOT LIMITED TO:
Directs the activities of the claims and research/audit staff.
Ensure timely, accurate processing of all claims, encounter information and adjustment requests.
Ensure production of accurate reports of aging, production and quality stats for Claims and Research/Audit
Ensure resolution of system programming issues in coordination with IT personnel.
Ensures compliance of all CMS, DMHC and HHS requirements.
Supervises claims department and Research/Audit unit.
Documents departmental policies and procedures and updates manuals as necessary.
Ensures that all policies and procedures related to processing of claims are communicated to staff and training is performed as needed.
Assigns and supervises work to ensure efficient operation and compliance with procedures.
Supervises claims and Research/ Audit supervisors/leads and delegates and oversees supervisory tasks.
Oversees appeals and Provider Dispute processing to ensure that procedures and documentation comply with AB1455, CMS and health plan standards.
Hires, trains, counsels, and discipline employees.
Documents, conducts, and/or reviews employee performance appraisals.
Maintains accurate individual performance records and manages actual performance to meet expected performance levels.
Maintains accurate staffing and performance records.
Serves as a member of the management and service improvement teams.
Serves as the primary contact and information resource for health plan auditors during the audit planning phase and during the actual on-site audit. Requests selection reports and coordinates the preparation of documentation to be reviewed by the auditors.
Prepares and implements corrective action plans, if needed, for any audit findings that require correction.
Perform other duties as assigned.
What qualifications you will need:
Bachelor’s degree or equivalent work experience required
Minimum five (5) years of experience in a health insurance or managed care environment or equivalent education/experience such as in claims adjudication with knowledge in healthcare benefits, benefit administration and health care delivery from either a payer or provider perspective required
Minimum of five (5) years of experience managing personnel with at least two (2) years managing personnel in a claims processing environment required
This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved).
Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare’s graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare’s commitment to the care and improvement of human life.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
“Bricks and mortar do not make a hospital. People do.”- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Claims Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
