Healthcare Claims Operations Manager

Naphcare, Inc.; Edgemont (AL); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401K

Tuition assistance

Referral bonuses

Paid time off

CMEs

Job summary

NaphCare, Inc. is seeking a Claims Review Manager at our Corporate Headquarters in Birmingham, AL. You will lead a team reviewing medical authorizations and reconciling claims, partnering with scheduling to ensure timely processing and accuracy.

Ideal candidates bring healthcare claims experience, strong data handling skills, and a focus on process improvements to boost efficiency and reduce errors. This role offers growth within a large correctional healthcare provider.

Qualifications

• High School Diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, business, or related field preferred.
• Three (3) years minimum experience in a healthcare claims, billing or medical authorization setting.
• Ability to prioritize, delegate, and meet deadlines in a high-volume environment.
• Working knowledge of medical claims, medical terminology, medical records, and medical authorization processes.
• Strong written, verbal and organizational skills.
• Working knowledge of claim demographic information.
• Computer skills, including proficiency in Microsoft Office Suite, particularly Excel.

Responsibilities

• Oversee a team of claims specialists reviewing authorizations for medical procedures and reconciling claims.
• Review medical authorizations in scheduling system to resolve outstanding claims.
• Manage team to ensure timely work with minimal errors and meet internal deadlines.
• Develop and deliver regular reports on team analytics and KPIs.
• Identify and resolve operational challenges, proposing process improvements.
• Maintain confidentiality of medical records and patient data.
• Work with large data volumes and maintain high accuracy.

Skills

Data entry

Attention to detail

High-volume processing

Education

Healthcare administration degree preferred

Tools

Microsoft Excel

Job description

NaphCare, Inc. is seeking a Claims Review Manager at our Corporate Headquarters in Birmingham, AL. You will lead a team reviewing medical authorizations and reconciling claims, partnering with scheduling to ensure timely processing and accuracy.

Ideal candidates bring healthcare claims experience, strong data handling skills, and a focus on process improvements to boost efficiency and reduce errors. This role offers growth within a large correctional healthcare provider.