Manager - Health Services
$54,300–$119,340 year
RemoteUnited States
Job Summary
Coordinate identification of potential claim editing and clinical program enhancements to ensure compliance with Medicare NCDs, LCDs, and federal/state legislation. Collaborate with functional leads and business areas to maintain quality and end-to-end payment accuracy in the Medicare NCD/LCD and federal/state legislation policy space. Provide support and management for savings opportunities and provider/customer deviation implementation while monitoring compliance strategies and escalating risks to leadership. Requires 5+ years in managed care, 3+ years in claims processing, and proficiency in ClaimsXten. Full-time remote role with a weekly schedule of 40 hours.
Required Qualifications
- Strong knowledge of Compliance Program Guidelines including CMS Medicare NCD/LCD, Federal, and State Legislation
- 3+ years processing and/or researching claims for appropriate claim editing
- 3+ years experience in successfully meeting project deliverables
- 5+ years in Managed Care/Healthcare experience
- High school Diploma
- Bachelor's degree
Desired Qualifications
- Current Registered Nurse (RN)
- Certified Professional Coder (CPC)
- Medicare Rules and Regulations
- Healthcare Compliance experience
- Proficiency in ClaimsXten
- Bachelors degree (Preferred)
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