What are the responsibilities and job description for the Claims Manager position at AMPS?
Job Type
Full-time
Description
The Claims Manager is responsible for the daily management of the Medical Claims Processing team members. This position demonstrates high levels of expertise in the department’s operations; provides training and staff development; performs administrative duties and support to deliver high levels of service, quality and production. This position should have a comprehensive understanding of the Plan Documents/Guidelines under their scope of responsibility.
Essential Job Duties
Education/Experience:
Full-time
Description
The Claims Manager is responsible for the daily management of the Medical Claims Processing team members. This position demonstrates high levels of expertise in the department’s operations; provides training and staff development; performs administrative duties and support to deliver high levels of service, quality and production. This position should have a comprehensive understanding of the Plan Documents/Guidelines under their scope of responsibility.
Essential Job Duties
- Maintain HIPAA/PII guidelines to ensure the confidentiality of all calls and documents
- Administrative
- Serve as a liaison between departments, vendors and clients to ensure collaborative progress
- Demonstrate strategic business acumen in decisions affecting bottom line focus
- Generate and deliver accurate and timely reports
- Assist with troubleshooting for technical issues
- Customer Service
- Serve as a role model in demonstrating core values of customer service
- Encourage continuous learning, personal development and accountability through team members
- Provide timely and thorough responses to internal and external customers
- Escalate difficult issues to the appropriate channels
- Assist in the processing and resolution of escalated issues
- Quality Assurance
- Ensure team compliance with service standards
- Follow trends within assigned scope and alert appropriate parties of any trends that fall outside quality parameters
- Develop and execute plans to meet established goals
- Provide continuous feedback to strengthen and optimize quality performance
- Work cross-departmentally to improve or streamline procedures
- Maintain up to date knowledge on industry trends and look for new data sources
- Develop new and improve current internal processes to improve overall quality
- Special projects as assigned
- Conduct regular performance evaluations of employees and provide ongoing feedback and coaching as necessary
- Address and counsel employees on behavioral or performance problems and implement corrective action as necessary
- Explain and administer company policies required for team members to perform duties successfully
- Distribute and monitor departmental workloads to ensure adequate coverage while meeting quality and service levels
- Oversee new and ongoing training and update training manuals
- Coordinate and actively participate in departmental meetings
- Excellent verbal and written communication skills with high attention to detail
- Excellent customer service skills
- Strong analytical and problem-solving skills
- Confident decision-making abilities
- Demonstrated ability to work independently, prioritize workloads and manage priorities to meet deadlines
Education/Experience:
- College degree or equivalent required
- Degree in Medical Billing and Coding or related field preferred
- Knowledge of medical terminology preferred
- 7 -10 years Claims Examiner experience or equivalent required
- 4 -7 years management experience required
- Indoor office environment with moderate noise
- Intermittent physical effort may include lifting as much as 25 lbs., walking, stopping, kneeling, crouching or crawling may be required
- Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing
- Normal vision abilities required including close vision and ability to adjust focus