E-Claims IT Development Manager
Direct the configuration of Claims configuration, contract payment terms and benefits which helps providers improve critical areas of their operations, including Revenue Cycle, Supply Chain, Credentialing, HR and Payroll, Legal, and Quality Assurance and Compliance.
Implement, Identify, develop and supporting all departments that use Claims and to direct the automated workflow and efficiency in which the system evaluates, processes and reports information from an IT Analytics perspective including authorization process, benefit management, billing & accounts receivables, capitation, claims processing, liability recovery, medical management, membership processing, pricing management, and Provider benefits.
Manages all functions of the Provider Enrollment and Credentialing Functions.
Develop designs the configuration of claims software system to support all areas involved.
Ensures Code sets, Procedure codes, diagnosis codes, DRGs, counters, super-tables, and Claims software configuration tables are used in provider, membership, benefits, pricing, medical management, claims and finance which includes benefit design, main default tables, alt provider records, specialty capitation and medical management.
Pricing, provider pay classes, counters and fee schedules per various provider agreements.
Medical Management, Finance - Employer Group Billing, Claims Payable, Capitation Payable and Accounts Payable. Correspondence Generator, including letters, ID Cards and batch letter generation jobs. Liability Recovery, which includes LR tables, AY tables and COB.
Regularly collaborates with sales, product development, provider contracting, claims Accounting, underwriting and payment Integrity to support contracted agreements
Manage IT Configuration budget and expense costs.
Participate on Committees/Teams including Medical Policy Committee, Payment Policy, Network Operations and Product Development.
Required skills and experience:
Bachelor’ s degree preferred
10 years Insurance or Healthcare Claims configuration management experience
Experience with Claims system configuration
Experience with health care insurance, health care provider is required
Advanced claims processing and system configuration
Prior leadership managing claims configuration process A-Z and compliance regulations background.
Facets or other Health Insurance Claims Software configuration
Some budgeting background ideal
Strong Project Management skills
Advanced knowledge of: Procedure codes, diagnosis codes, DRGs, counters, super-tables, and Claims software configuration tables are used in provider, membership, benefits, pricing, medical management, claims and finance which includes benefit design, main default tables, alt provider records, specialty capitation and medical management.
Exceptional IT Configuration, AWD-Claims Management Systems or solutions experience
Job Type: Full Time - Direct Hire
Location: Connecticut/Mass Border
Salary: $130-150K with Bonus,(depending on education, experience)
Excellent benefits, PTO, tuition reimbursement offered
Send confidential resume to Krisha Morander -Email: KrishaM@JMorrissey.com