Senior Medicare Claims Operations Manager

Zing Health, Inc.; Springfield (IL); Presencial; USD 120.000 - 150.000; Jornada completa

Descripción de la vacante

Zing Health, Inc. in Springfield, IL seeks a Medicare Claims Operations Leader to manage the implementation and ongoing support of Medicare claims processes across the company. You will ensure CMS compliance, monitor operations, and drive improvements in controls and documentation.

The role requires deep knowledge of Medicare regulations, experience in provider communications, and the ability to coordinate across multiple departments to support MA plans and DSNP/ACA operations.

Formación

• Four (4) years minimum in a manager level role or above.
• Four (4) years of Medicare claims experience required, and Medicare/DSNP/ACA Exchange operations experience preferred.
• Seven (7) years of health plan administration experience

Responsabilidades

• Oversee claims production and vendor oversight for Medicare Advantage line of business.
• Establish, implement, and provide improvements to internal controls and department policies and procedures.
• Maintains knowledge of government regulations as it pertains to claims payments and recognized claims processing standards.
• Investigates and responds to letters of inquiry on claims from members, providers, networks, and government agencies.
• Ensure adequate quality controls and participate with support departments to analyze the root cause of claim payment variations.
• Ensure claim support services achieve high provider satisfaction and timely dispute/appeal responsiveness.

Conocimientos

Medicare claims experience

Managerial experience

Health plan administration

Descripción del empleo

Zing Health, Inc. in Springfield, IL seeks a Medicare Claims Operations Leader to manage the implementation and ongoing support of Medicare claims processes across the company. You will ensure CMS compliance, monitor operations, and drive improvements in controls and documentation.

The role requires deep knowledge of Medicare regulations, experience in provider communications, and the ability to coordinate across multiple departments to support MA plans and DSNP/ACA operations.