UCLA Health
Claims Manager
UCLA Health, Los Angeles, California, United States, 90079
We are seeking a detail-oriented and experienced Claims Manager to join our Claims leadership team. In this key role, you will oversee a dedicated team of claims examiners, auditors, and support staff, and monitor the department for regulatory compliance. You will be responsible for implementing and maintaining efficient claims adjudication processes that utilize technology to automate workflows and maximize the accuracy of claim payments.The ideal candidate will demonstrate strong leadership and communication skills, fostering collaborative relationships with colleagues and team members. You will promote high-quality customer service and identify opportunities for workflow improvements to boost effectiveness and productivity. Additionally, you will research and resolve complex claims issues and develop standard operating procedures for handling various intricate claim scenarios.Salary Range:
$92,600 - $202,200 AnnuallyQualifications
High School Diploma requiredBachelor's Degree in Business Administration, Health Care or other related field preferred or equivalent work experience5 years previous experience in claims operations specifically related to Medicare Advantage or managed care in a complex and diversified healthcare or health insurance company3 years experience managing personnel with at least 2 years managing personnel in a claims processing environmentExtensive knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards related to specificity, as well as Revenue and HCPCS codingStrong working knowledge of provider network/IPA arrangements and reimbursement methodologies and of health benefit plan conceptsConversant with standard electronic and paper claim formats; familiarity with American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) coding guidelines such as the National Correct Coding Initiative (NCCI) edits and their relation to clinical logic in claims adjudicationExperience with Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization toolsStrong knowledge of all regulatory standards such as HIPAA, DMHC, AB1455, and CMS reporting requirementsFamiliarity with claims edit softwareAbility to analyze and organize complex federal and private insurance regulationsStrong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essentialAbility to support the working hours of the departmentAbility to travel/attend off-site meetings and conferencesUCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.
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$92,600 - $202,200 AnnuallyQualifications
High School Diploma requiredBachelor's Degree in Business Administration, Health Care or other related field preferred or equivalent work experience5 years previous experience in claims operations specifically related to Medicare Advantage or managed care in a complex and diversified healthcare or health insurance company3 years experience managing personnel with at least 2 years managing personnel in a claims processing environmentExtensive knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards related to specificity, as well as Revenue and HCPCS codingStrong working knowledge of provider network/IPA arrangements and reimbursement methodologies and of health benefit plan conceptsConversant with standard electronic and paper claim formats; familiarity with American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) coding guidelines such as the National Correct Coding Initiative (NCCI) edits and their relation to clinical logic in claims adjudicationExperience with Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization toolsStrong knowledge of all regulatory standards such as HIPAA, DMHC, AB1455, and CMS reporting requirementsFamiliarity with claims edit softwareAbility to analyze and organize complex federal and private insurance regulationsStrong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essentialAbility to support the working hours of the departmentAbility to travel/attend off-site meetings and conferencesUCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.
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