Director of Claims Operations & Strategy

Prominence Health; Reno (NV); On-site; USD 150,000 - 190,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Challenging and rewarding work环境

Competitive Compensation & Generous PM

Excellent Medical, Dental, Vision and药

401(K) with company match and stock

SoFi Student Loan Refinancing Program

Career development opportunities with

Benefits Website: benefits.uhsguest

Job summary

Prominence Health in Reno, NV is seeking a Director of Claims to set the strategic direction, plan and run all claims operations. You will ensure compliance with federal and state regulations while driving efficiency and quality through technology and process improvements.

The ideal candidate has extensive Medicare/Medicaid claims leadership, expertise with QNXT or similar adjudication systems, and a track record of partnering with executives to align claims with organizational goals.

Qualifications

• Bachelor’s degree in health care administration or business management or equivalent.
• 5+ years’ experience in claims management with direct Medicare experience.
• 5+ years’ experience budgeting, forecasting and collaborating with executive leadership.
• Strong leadership and cross-functional collaboration abilities.
• Deep understanding of CPT/ICD-10 and insurance billing practices.
• Familiarity with HIPAA, CMS guidelines, and regulatory audits.

Responsibilities

• Lead strategic direction and execution of all claims operations.
• Oversee departmental leadership and ensure regulatory compliance.
• Drive innovation through technology and process optimization.
• Collaborate with executive leadership to align claims with organizational goals.
• Manage departmental budgets and cross-functional initiatives to improve service delivery.

Skills

Leadership

Budgeting & forecasting

Cross-functional collaboration

Regulatory compliance

Medical terminology & coding (CPT, ICD

Project management

Communication skills

Data-driven decision making

Claims systems experience

Education

Bachelor’s degree in health care administration or business management

Tools

QNXT

Job description

Prominence Health in Reno, NV is seeking a Director of Claims to set the strategic direction, plan and run all claims operations. You will ensure compliance with federal and state regulations while driving efficiency and quality through technology and process improvements.

The ideal candidate has extensive Medicare/Medicaid claims leadership, expertise with QNXT or similar adjudication systems, and a track record of partnering with executives to align claims with organizational goals.