At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. MemorialCare stands for excellence in Healthcare. Across our family of medical centers and physician groups, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
The Claims Compliance Manager has primary responsibility for oversight of the Claims Audit functions, Claims Adjustment projects, and Health Plan Demands. Acts as liaison between MCMF and Health Plans for all claims related audits, DMHC audits, CMS audits and reporting and delegation audits. Responsible for maintaining claims policies and procedures and insuring that they are current and reflect the workflow process of MCMF, not limited to GNP, MCMG and EMG.
Education: * Bachelor’s degree in Business, Health Care Administration or related field or equivalent experience required.
Experience * Minimum 3-5 years supervisory experience or demonstrated leadership ability required * Comprehensive knowledge of Medicare, ODAG, and Part C reporting requirements * Working knowledge of Claims Information Systems * Comprehensive knowledge of CPT, ICD-10, inpatient procedure coding, HCPCS Revenue Codes, medical terminology, and COB required * Microsoft Excel, Work, and Access skills * Detail oriented with excellent verbal and written communication skills * Demonstrates effective communication, interpersonal, and organization skills * Ability to plan and identify opportunities to effectively utilize resources * Excellent critical thinking skills