Remote Senior Manager, Health Plan Claims and CMS Audits

Millennium Physician Group; United States; Remote; USD 140.000 - 200.000; Vollzeit

Benefits dieser Stelle

3 weeks PTO & 8 paid holidays

Medical, Dental, Vision

Fully remote

Zusammenfassung

Millennium Physician Group is actively seeking a Senior Manager, Claims Health Plan Readiness to lead regulatory compliance and CMS audit activities across our health plan operations. This role demands strategic oversight, cross-functional collaboration, and a proven track record in improving audit readiness and payment integrity.

You will partner with Compliance, Finance, IT, and Operational leaders to translate complex CMS requirements into practical procedures, controls, and enhanced

Qualifikationen

• Bachelor's degree or equivalent clinical/industry experience.
• 8+ years in healthcare claims, adjudication, or regulatory compliance.
• 3–5+ years of leadership overseeing teams or programs.
• Strong CMS knowledge and health plan regulatory compliance experience.

Aufgaben

• Develop and execute claims health plan readiness strategies with regulatory compliance and CMS audit readiness as priorities.
• Lead teams to ensure compliant claims adjudication, accurate reimbursement, and audit preparedness.
• Coordinate health plan and CMS audits, including documentation, evidence, and responses.
• Translate regulatory changes into scalable policies, system requirements, and procedures.
• Identify and remediate systemic adjudication errors, denials, and coding issues.
• Sponsor system improvements in claims workflows, payment integrity, and coding controls.

Kenntnisse

Regulatory compliance

CMS audits

Leadership

Analytical thinking

Stakeholder management

Ausbildung

Bachelor's degree

Advanced degree

Tools

Facets

QNXT

EDI 837/835

Jobbeschreibung

Millennium Physician Group is actively seeking a Senior Manager, Claims Health Plan Readiness to lead regulatory compliance and CMS audit activities across our health plan operations. This role demands strategic oversight, cross-functional collaboration, and a proven track record in improving audit readiness and payment integrity.

You will partner with Compliance, Finance, IT, and Operational leaders to translate complex CMS requirements into practical procedures, controls, and enhanced