Director Of Claims Management

NaphCare; Birmingham; On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player in medical technology is seeking a Director of Claims Management to lead a growing team in Birmingham. This role is pivotal in shaping the future of claims processing within correctional healthcare, ensuring that high standards are met while supporting a diverse patient population. The ideal candidate will possess strong leadership and communication skills, with a solid background in medical claims adjudication. Join a dynamic company dedicated to excellence in healthcare and employee growth, where your contributions will make a significant impact in an essential field.

Benefits

Outstanding Benefits

Opportunities for Advancement

Engaged Corporate Support Team

Qualifications

• 5+ years of supervisory experience in medical claims adjudication.
• Strong leadership and training skills required.

Responsibilities

• Develop long-term plans for claims organization and monitor team performance.
• Train new employees and ensure compliance with NaphCare processes.

Skills

Leadership Skills

Communication Skills

Attention to Detail

Customer Service

Data Analysis

Medical Terminology

Follow-up Skills

Education

Bachelor's Degree

Tools

Microsoft Office Suite

Job description

Overview

NaphCare has an excellent opportunity for a Director of Claims Management to join our Corporate Headquarters in Birmingham, AL.

NaphCare is a family-owned, medical technology company that has been delivering high-quality healthcare to correctional facilities across the nation for over 30 years. Come join our team of over 4000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do.

NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare as you use our cutting-edge resources, including our award-winning electronic operating system.

NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up-to-date. This service streamlines continuing education for all NaphCare Employees to meet state-specific requirements for maintaining licensing.

With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different.

We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.

Responsibilities

Responsibilities:

• Develop long-term plan for claims organization as the division continues its growth path.
• Establish and monitor benchmarks and metrics for team performance.
• Provide direction and oversight to departmental Claim Managers.
• Analyze reports and review internal audits to ensure benchmarks are met.
• Manage timecards, coordinate time off requests, and coverage.
• Handle escalations with Claims team members, clients, and providers to ensure a resolution is achieved.
• Appropriately communicate information both verbally and in writing to clients, team members, and supervisors.
• Communicate with other departments as needed to ensure claims are processed accurately and timely.
• Train all new employees and coordinate ongoing training for current team members to ensure all NaphCare processes and job functions are followed.
• Delegate tasks to the team appropriately and provide support to the team members.
• Utilize medical terminology knowledge to review claims, medical records, and authorization scenarios.
• Exhibit a high comfort level in working with large volumes of data.
• Demonstrate a strong attention to detail and a commitment to customer service throughout the claims process.
• Work closely with the Vice President of Claims Management to ensure claims processes and systems are operating as expected.
• Additional duties and specific projects as assigned.

Qualifications

Qualifications:

• Bachelor’s degree required
• 5+ years supervisory/managerial experience in medical claims adjudication.
• 5+ years of medical claims processing.
• Medicare/Medicaid claims processing experience preferred.
• Knowledge of Medicare guidelines and payment methodologies.
• Knowledge of medical terminology, ICD9, HCPCS and CPT coding, and an ability to understand medical records.
• Strong leadership and training skills.
• Strong Human Resource skills.
• Strong follow-up skills.
• Excellence in Microsoft Office Suite and strong written and verbal communication skills required.

We know you may have questions before applying. To speak to a recruiter directly, email your questions and/or resume to [e-mail] with the position and location you’re interested in.

Equal Opportunity Employer: disability/veteran