Claims Manager, Denver Health Medical Plan
We are recruiting for a Claims Manager, Denver Health Medical Plan to join our team! We are here for life's journey.
Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:
Humanity in action, Triumph in hardship, Transformation in health.
Department Managed Care Administration Remote opportunity for residents of Colorado, Illinois, Kentucky, Mississippi, New Hampshire, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin.
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.
Essential Functions :
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.
Education :
Bachelor's Degree Required Work Experience :
Five years of health care claims experience, Required and Two years of lead or supervisory experience Required Licenses :
Knowledge, Skills and Abilities :
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 Remote opportunity for residents of Colorado, Illinois, Kentucky, Mississippi, New Hampshire, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin Shift Days (United States of America) Work Type Regular Salary $93,000.
00 - $139,600.
00 / yr Benefits Competitive pay Outstanding benefits Education opportunities Shared leadership and advancement opportunity State-of-the-art facilities Immediate retirement plan matching Professional clinical advancement program Participation in evidence-based projects Public Service Loan Forgiveness (PSLF) eligible employer National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison& Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured.
Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community.
For read more about our commitment to diversity visit:
Recommended Skills Onboarding Negotiation Decision Making Training And Development Workforce Planning Retaining Wall Estimated Salary: $20 to $28 per hour based on qualifications.
Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:
Humanity in action, Triumph in hardship, Transformation in health.
Department Managed Care Administration Remote opportunity for residents of Colorado, Illinois, Kentucky, Mississippi, New Hampshire, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin.
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.
Essential Functions :
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.
Education :
Bachelor's Degree Required Work Experience :
Five years of health care claims experience, Required and Two years of lead or supervisory experience Required Licenses :
Knowledge, Skills and Abilities :
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 Remote opportunity for residents of Colorado, Illinois, Kentucky, Mississippi, New Hampshire, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin Shift Days (United States of America) Work Type Regular Salary $93,000.
00 - $139,600.
00 / yr Benefits Competitive pay Outstanding benefits Education opportunities Shared leadership and advancement opportunity State-of-the-art facilities Immediate retirement plan matching Professional clinical advancement program Participation in evidence-based projects Public Service Loan Forgiveness (PSLF) eligible employer National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison& Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured.
Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community.
For read more about our commitment to diversity visit:
Recommended Skills Onboarding Negotiation Decision Making Training And Development Workforce Planning Retaining Wall Estimated Salary: $20 to $28 per hour based on qualifications.
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