Medicare Claims Operations Lead

Zing Health Holdings Inc; Illinois; On-site; USD 95,000 - 150,000; Full time

Job summary

Zing Health Holdings Inc is seeking a Medicare claims operations leader responsible for the implementation and ongoing support of Medicare claims processes across the company. You will ensure CMS compliance, develop and enforce policies, monitor performance, coordinate with cross-functional teams and vendors, and lead staff to ensure accurate payments and timely responses to inquiries.

Four (4) years of Medicare claims experience and seven (7) years in health plan administration are typical

Qualifications

• Four years of Medicare claims experience is required.
• Seven years of health plan administration experience is preferred.

Responsibilities

• Oversee Medicare Advantage claims production and vendor oversight.
• Ensure compliance with CMS regulations and MA plan contracts.
• Develop and implement policies and procedures for claims operations.
• Monitor performance, provide training and coaching to staff, and drive process improvements.
• Coordinate with Core Configuration teams and vendors on claims systems and status reporting.
• Respond to inquiries from members, providers, and government agencies.
• Support internal audits and corrective action plans as needed.

Skills

Medicare claims knowledge

CMS regulations

Leadership/management

Tools

EDI systems

Job description

Zing Health Holdings Inc is seeking a Medicare claims operations leader responsible for the implementation and ongoing support of Medicare claims processes across the company. You will ensure CMS compliance, develop and enforce policies, monitor performance, coordinate with cross-functional teams and vendors, and lead staff to ensure accurate payments and timely responses to inquiries.

Four (4) years of Medicare claims experience and seven (7) years in health plan administration are typical