Hybrid Claims Operations Manager

LaSalle Medical Associates IPA; San Bernardino (CA); In loco; USD 87.000 - 98.000; Tempo pieno

Descrizione del lavoro

LaSalle Medical Associates IPA seeks a Claims Manager to oversee the daily operations of the Claims Department within the MSO and supervise Claims Examiners to ensure accurate, timely adjudication of professional and institutional claims in line with health plan contracts and regulations.

The role focuses on monitoring claims inventory and quality metrics, maintaining turnaround times, and ensuring compliance with DMHC, CMS, and DHCS requirements while supporting delegated managed care

Competenze

• Minimum: High School diploma or equivalent.
• Preferred: Bachelor’s degree in Healthcare Administration, Business Administration, or related field.
• Minimum: At least five years of managed care claims processing experience. Two or more years of supervisory or leadership experience.
• Preferred: Experience in MSO, IPA, or delegated managed care environment; Medicare, Medi-Cal, Commercial claims; claims systems like EZ Cap, EPIC.

Mansioni

• Oversee daily operations of the Claims Department within the MSO.
• Lead and supervise Claims Examiners to ensure accurate adjudication of professional and institutional claims.
• Monitor claims inventory, production, and quality metrics to meet turnaround time standards.
• Ensure regulatory compliance with DMHC, CMS, DHCS requirements and audits.

Conoscenze

Claims processing

Regulatory compliance

Leadership

Analytics

Formazione

High School diploma or equivalent

Bachelor’s degree in Healthcare Administration or related field

Strumenti

EZ Cap

EPIC

Descrizione del lavoro

LaSalle Medical Associates IPA seeks a Claims Manager to oversee the daily operations of the Claims Department within the MSO and supervise Claims Examiners to ensure accurate, timely adjudication of professional and institutional claims in line with health plan contracts and regulations.

The role focuses on monitoring claims inventory and quality metrics, maintaining turnaround times, and ensuring compliance with DMHC, CMS, and DHCS requirements while supporting delegated managed care