Manager Claims Admin - Revenue Cycle Claims Processing - Sharp Corporate - Day Shift - Full Time

300 Sharp HealthCare; United States; On-site; USD 73,000 - 116,000; Full time

Job summary

Sharp HealthCare seeks a seasoned claims operations leader to oversee the claims units across Sharp Rees-Stealy, Sharp Community Medical Group, EOHD, Clinical Trials, and Transplant services. You will ensure prompt, accurate processing of claims and maintain strong collaboration with health plans, providers, and members.

This role requires 3 years in the HMO industry with claims and customer service experience, plus 2 years of leadership. EPIC Tapestry experience is preferred.

Qualifications

• 3 years' experience in the HMO industry to include claims, customer service, and/or health insurance management.
• 2 years leadership experience.
• Bachelor's degree in business, health services, management, or relevant field; or 4 years of relevant experience in the healthcare industry may substitute for the degree.

Responsibilities

• Leadership: recruit, hire, motivate staff and conduct performance appraisals.
• Daily Operations: manage the daily operations of the claims department with turnaround times and accuracy targets.
• Training: coordinate staff training and establish quality standards.
• Application Management: participate in software workflow and system integration improvements.
• Internal and External Customer Service: interface with health plans, providers, members, and medical groups to resolve issues.
• Safety: promote safe work practices and attend the annual Safety Fair.

Skills

Leadership

Customer service

Health insurance management

Claims processing

Education

Bachelor's degree in business/health services/management or related field

Tools

EPIC Tapestry

Job description

Hours

Shift Start Time: 8 AM

Shift End Time: 5 PM

AWS Hours Requirement: 8/40 - 8 Hour Shift

Weekend Requirements: No Weekends

On-Call Required: No

Hourly Pay Range

Hourly Pay Range (Minimum - Midpoint - Maximum): $53.050 - $68.460 - $83.860

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

This position manages the claims units for Sharp Managed Care Contracts. This includes but is not limited to claims for Sharp Rees-Stealy, Sharp Community Medical Group, and claims for EOHD, Clinical Trials, and Transplant services paid by Sharp HealthCare. This position is responsible for prompt, accurate, and efficient processing of claims.

Required Qualifications

• 3 years' experience in the HMO industry to include claims, customer service, and/or health insurance management.
• 2 years leadership experience.

Preferred Qualifications

• Experience with EPIC Tapestry.

Other Qualification Requirements

• Bachelor's degree in business, health services, management, or relevant field; or 4 years of relevant experience in the healthcare industry may substitute for the degree.

REQUIRED Essential Functions

• Leadership

  Display professionalism and teamwork in promoting the Mission, Goals, and Objectives of Sharp Healthcare. Recruit, hire, motivates staff to perform at a level that consistently meets expectations. Develop, train, counsel staff, and conduct performance appraisals. (Standard: Employee turnover rate kept at or below corporate standard and complete performance appraisals in a timely manner 98% of the time.

• Daily Operations

  Manage the daily operations of the claims department maintaining claim turnaround times at 95% processed within four weeks, 95% of the time, and maintaining accuracy rates of 95% procedural and 98% financial. Develop reporting and follow through mechanisms to document departmental efficiency and productivity. Responsible for the development and implementation of continuous quality improvement and measurement of claims unit effectiveness.

• Training

  Coordinate continuing staff training and establish quality and productivity standards to be reported monthly. Provide input into claims policy and procedure manuals. Effectively communicate departmental policies to staff and other affected areas.

• Application Management

  Participates in the development and implementation of improvements in software functionality, workflow and system integration.

• Internal and External Customer Service

  Interface with Health Plans, Providers, Members, and Medical Groups to resolve issues in a professional manner that maintains consistently positive relationships. Demonstrate a positive, professional and contributory posture in all matters requiring interface with customers, both internal and external. (Standard: Consistent positive feedback from staff, peers, and external customers. Less than 2 exceptions noted per year).

• Safety

  Demonstrate safe work practices by identifying and reporting potential safety hazards to appropriate personnel, including but not limited to the following: Assuring staff’s appropriate chair height, keyboard and screen placement, securing of electrical wiring, use of proper body mechanics, etc. Attend annual Safety Fair. (Standard: 1 exception noted per year and attends annual Safety Fair).

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Sharp HealthCare is a not-for-profit health care system based in San Diego, California, with four acute care hospitals, three specialty hospitals, three medical groups and a health plan.

We provide medical services in virtually all fields of medicine, including primary care, heart care, cancer, orthopedics, women’s health, rehabilitation, robotic surgery and bariatric surgery.

Sharp sets the community standard for exceptional care.

Sharp Grossmont Hospital and Sharp Memorial Hospital have received prestigious Magnet recognition by the American Nurses Credentialing Center for excellence in nursing practices and quality patient care.

At the heart of our organization are more than 18,000 affiliated physicians, nurses, staff and volunteers who are on a journey to make health care better for our patients and their families. It’s what we call The Sharp Experience – treating each person with dignity, compassion and respect, and using our clinical excellence and advanced technology to deliver the highest-quality patient care.

We are dedicated to transforming the health care experience by making Sharp the best place to work, the best place to practice medicine and the best place to receive care in San Diego.