Senior Director of Claims & Compliance

Oakland-Community-Health-Network; Troy (MI); Hybrid; USD 105,000 - 131,000; Full time

Job summary

Oakland Community Health Network seeks a Claims Management Director to lead planning, development, and operations of the claims system. You will guide executive decisions, implement plans, and ensure coding and billing compliance across programs.

The role requires extensive management experience in outpatient, Medicare/Medicaid billing, and professional reimbursements, with a focus on process improvement and regulatory adherence.

Qualifications

• Bachelor's degree in business administration or related field.
• RHIT or CPC certification required; must obtain if not held within 6 months of hire.

Responsibilities

• Provide strategic input on claims processing and payment decisions.
• Develop CM budget and auditing reports for leadership.
• Schedule and supervise audits related to claims issues and report findings.
• Manage day-to-day workflow and operations of claims management.
• Establish policies and procedures for claims processing and performance standards.
• Supervise department employees including hiring and performance management.
• Review settlements for compliance with procedures.
• Ensure CPT/ ICD coding accuracy and compliance.
• Analyze account details and respond to claims inquiries.
• Assist with pre-claim edits and coding guidance.
• Support providers with coding and billing documentation.
• Participate in committees and lead the OCHN Procedure Code Workgroup.

Skills

Leadership

Healthcare claims

Budgeting

Auditing

Policy development

Data analysis

Communication

Team management

Education

Bachelor's degree in business administration

RHIT or CPC certification

Tools

Claims management software

Job description

Oakland Community Health Network seeks a Claims Management Director to lead planning, development, and operations of the claims system. You will guide executive decisions, implement plans, and ensure coding and billing compliance across programs.

The role requires extensive management experience in outpatient, Medicare/Medicaid billing, and professional reimbursements, with a focus on process improvement and regulatory adherence.