What are the responsibilities and job description for the Claims Manager, Medicare Advantage Plan (Flexible-Hybrid) position at UCLA Health?
Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence. The Claims Manager of the Medicare Advantage Plan will:
- Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments.
- Foster a positive, high-performing team culture focused on quality and exceptional customer service
- Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures
- Empower the team to navigate challenging scenarios with confidence and consistency
We’re seeking a self-motivated, service-driven leader with:
Required:
- Bachelor’s degree in business, health care or a related field and/or equivalent work experience
- Five or more years of claims operations experience in a Medicare Advantage or related environment
- Three or more years of managing personnel in a claims processing environment
- In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
- Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.
- Knowledge of standard electronic and paper claim formats
- Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines
- Computer proficiency with Microsoft Office Suite and data visualization tools
- Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements
- Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
- Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)
- Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT
- Excellent problem identification, resolution, and analytical abilities
- Strong communication, interpersonal, and analytical skills
- Ability to develop, implement, and evaluate methods/systems to improve efficiency
- Ability to lead and facilitate cross-functional workgroups
- Proficiency in achieving compliance with regulatory requirements
- Ability to travel/attend off-site meetings and conferences
Preferred:
- Certified Professional Biller (CPB)
- Certified Revenue Cycle Representative (CRCR)
Salary Range: $95,400 - $208,300/annually
Salary : $95,400 - $208,300