What are the responsibilities and job description for the Director of Medical Claims position at Peyton Resource Group?
Our client, a leading healthcare organization, is seeking an experienced Director of Medical Claims to oversee and direct delegated claims operations, ensuring accuracy, compliance, and efficiency across the department. The ideal candidate is a strategic leader with deep expertise in Medicare Advantage and managed care environments who thrives in a fast-paced, data-driven setting.
Key Responsibilities
- Lead and manage the Claims department to ensure full compliance with Medicare Advantage, managed care delegation, company policies, and all applicable regulations.
- Define and execute strategic goals to improve claims accuracy, timeliness, efficiency, and alignment with organizational objectives.
- Manage, mentor, and evaluate staff setting expectations, conducting performance reviews, and fostering a culture of accountability and continuous learning.
- Establish and maintain departmental policies, procedures, and productivity standards that drive operational excellence.
- Monitor and analyze key performance metrics (claim accuracy, processing speed, audit results), identify trends, and implement corrective actions.
Qualifications
- 10 years in healthcare claims or revenue cycle management, with 5 years in a leadership role.
- Strong understanding of Medicare guidelines, managed care, and claims regulations.
- Proven experience overseeing delegated claims operations and maintaining compliance with payer and regulatory standards.
- Excellent analytical, communication, and leadership skills with a collaborative management style.
- Knowledge of Medicare Advantage claims adjudication and delegated claims audits is highly preferred.
Role will be onsite 5 days a week in San Antonio. Relocation assistance is provided.