Senior Hospital Claims Operations Manager

1199seiu; New York (NY); On-site; USD 85,000 - 120,000; Full time

Job summary

1199SEIU National Benefit Funds in New York, NY, seeks an experienced Hospital Claims Operations Manager to lead day-to-day processing in the Processor and Clerical Unit. You will supervise staff, direct workload distribution, and ensure accuracy and compliance with SPD guidelines, COB rules, and HIPAA.

The role requires a Bachelor’s degree and at least five years of hospital claims processing experience, including two years in supervision.

Qualifications

• Bachelor’s degree or equivalent years of work experience required.
• Five+ years hospital claims processing, QA, auditing; two+ years supervisor experience.
• Knowledge of CPT, ICD-10, HCPCS, UB-04 and hospital reimbursement methodologies.
• Knowledge of eligibility, medical terminology, COB and third-party reimbursement.
• Basic skills in Word and Excel preferred.
• Strong leadership; independent decision-making, planning, scheduling and reporting.
• Analytical, critical thinking, interpersonal and communication skills.
• Excellent organizational skills; multi-task and meet deadlines.

Responsibilities

• Oversee day-to-day operations of Hospital Claims Department in the Processor and Clerical Unit.
• Provide direction and support to unit leadership in work distribution and audits.
• Ensure timely, accurate processing of hospital claims, emails, and tickets per SPD guidelines and COB rules.
• Manage staff per CBA, assess performance, and coordinate training and QA results.
• Address HIPAA and Compliance standards and corrective actions as needed.
• Monitor QNXT reports, DMS queues, Pend Workflow, and Call Tracking systems.
• Assist in resolving complex issues; release high-dollar claims at appropriate levels.
• Develop policies/procedures and pursue continuous process improvement.
• Collaborate with Care Management, Provider Relations, IT, and vendors to resolve issues.
• Oversee testing related to QNXT upgrades and system enhancements.
• Serve as backup to Assistant Director and QA Manager when needed.

Skills

Leadership

Data reporting

Auditing

CPT/ICD-10/HCPCS

Document management

Decision making

Analytical thinking

Communication

Education

Bachelor’s degree

Tools

Microsoft Word

Microsoft Excel

Job description

1199SEIU National Benefit Funds in New York, NY, seeks an experienced Hospital Claims Operations Manager to lead day-to-day processing in the Processor and Clerical Unit. You will supervise staff, direct workload distribution, and ensure accuracy and compliance with SPD guidelines, COB rules, and HIPAA.

The role requires a Bachelor’s degree and at least five years of hospital claims processing experience, including two years in supervision.