Senior Manager, Claims & Contract Support

Location: Columbus, OH
Joining this team means you'll be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. The group is a fast, agile, customer-focused organization with a commitment to implementing the latest technologies.
 
Our client serves more than 55 million managed care members through their portfolio of high-quality commercial and government sponsored healthcare programs. The broad offering of programs that they provide has helped them to build both capacity and capability to successfully navigate a changing healthcare environment, while continuing to offer better health outcomes at lower costs.
 
Position Purpose:
Manage the implementation all provider contracts, including any pertinent changes and modifications applicable to these contracts. Provide Health Plan management with all necessary data to allow for expedient resolution of claims issues.
 
Job Description:
  • Oversee the claims operation function, including contracting and configuration
  • Identify and manage risks, resolve conflicts and remove barriers that impede area’s ability to achieve goals and performance expectations
  • Provide management to expedite resolution of claims issues and support in policy decisions related to claims operations
  • Manage and identify process improvement opportunities in the health plan’s workflow to assure timely, accurate submission and implementation of contracts
  • Perform random audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
  • Act as health plan interface on software product upgrades and implementations that affect contract implementation
  • Interface with all organizational levels to mobilize commitment and ensure accurate configuration, contract implementation, and claims operations
  • Proactively interact with external stakeholders as it relates to new product implementations
  • Serve as the subject matter expert in resolution of claims and configuration issues
  • Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation
 
 
Qualifications:
Education/Experience:
  • Bachelor’s degree in related field or equivalent experience.
  • 6+ years of provider relations, provider contracting or claims administration experience, preferably in a managed care environment.
  • Experience with Medicare and Medicaid claims and system configuration.
 
Licenses/Certifications:
  • N/A
 
Our client offers options that allow you to do more than just plan for retirement. Their programs allow shared success with employees.
  • 401(k) with company match
  • Employee stock purchase plan
  • Training and Learning Opportunities/Tuition Reimbursement/Educational Assistance
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location
 
Equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
 
 
 
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 
www.medenlist.com 
https://www.indeedjobs.com/proenlist?hl=en_US
 
 
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