Claims Manager

Important Note:

This is a Contra Costa County civil service position (Patient Accounting Manager). Applicants are placed on a countywide eligibility list. Applicants interested in the CCHP Claims Manager should apply through this posting to be considered.

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Company Description

Contra Costa Health is offering an excellent opportunity for two (2) Managers within Contra Costa Health Plan (CCHP)'s Claims Department. CCHP is a federally qualified, state-licensed, and county-sponsored Health Maintenance Organization (HMO) serving Contra Costa County in the East Bay of the San Francisco Bay Area. Established in 1973, CCHP was the first county-sponsored HMO in the United States and today serves as the largest managed care health plan in Contra Costa County, covering more than 250,000 residents.

CCHP is committed to providing equitable, accessible, and high-quality healthcare to our culturally and linguistically diverse members. Within CCHP, the Claims Manager will serve as the manager of the CCHP Claims Department, overseeing claims operations to ensure accurate and timely processing, compliance with Medi-Cal, Medicare, and commercial payer requirements, and alignment with the plan's mission of supporting member and provider needs.

Contra Costa Health (CCH), the broader health system in which CCHP is housed, is the largest department in Contra Costa County with more than 4,000 employees, providing integrated healthcare services and serving as the safety net for low-income and uninsured residents.

Role Description

This is a full-time, on-site role for a Claims Manager (Patient Accounting Manager) at Contra Costa Health Plan located in Martinez, CA. The Claims Manager will oversee claims handling and processing operations, ensure efficiency and compliance with policies, and manage a team to maintain the accuracy and timeliness of claims activities. This role also involves analyzing claims data, addressing escalated issues, and working to improve claims management processes and systems in collaboration with internal teams.

Responsibilities

• Managing and supervising claims operations for CCHP, including claims processing, adjustments, and payment integrity
• Selecting, training, evaluating, and monitoring the performance of subordinate personnel, including supervisors and clerical staff
• Overseeing workflows to ensure timely and accurate adjudication of claims across Medi-Cal, Medicare, and commercial lines of business
• Serving as liaison with providers, county healthcare staff, and external stakeholders to resolve claims-related issues
• Ensuring compliance with federal, state, and local regulations as well as managed care, Medi-Cal, and Medicare standards
• Monitoring claims performance metrics, including timeliness, accuracy, and compliance with DHCS (Department of Health Care Services), DMHC (Department of Managed Health Care) requirements, and CMS (Center for Medicare and Medicaid Services)
• Reporting key claims issues, trends, and operational updates to higher management in a timely manner
• Collaborating with Finance, Utilization Management, Compliance, and other divisions to align claims operations with organizational goals.

Minimum Qualification:

• Education: Possession of a Bachelor's degree from an accredited college or university with a major in business administration, finance, accounting, health care administration or a closely related field.
• Experience: Three (3) years of full-time or its equivalent experience in an administrative, managerial or supervisory position with direct responsibility for delivery of patient business services, patient accounting services, insurance billing services, collection services or patient financial counseling services in a health care services organization.
• Substitution for Education:
• Possession of an Associate's Degree or successful completion of sixty (60) semester or ninety (90) quarter units from an accredited college or university, combined with two (2) years of full-time additional qualifying experience, may be substituted for the required Bachelor's degree; OR
• Possession and maintenance of one of the following professional certifications: Certified Healthcare Financial Professional (CHFP) issued by the Healthcare Finance Management Association (HFMA) or Certified Patient Account Manager (CPAM) or Certified Clinic Account Manager (CCAM) certifications issued by the American Association Of Healthcare Administrative Management (AAHAM); or Certified Patient Account Technician (CPAT) or Certified Clinic Account Technician (CCAT) combined with additional four (4) years of full-time qualifying experience may be substituted for the required Bachelor's degree.
• Substitution for Experience and Education: Five (5) years of full-time or its equivalent experience as an Account Clerk Supervisor in Contra Costa County may be substituted for the required education and experience.