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Manager, Healthcare Claims & Contract Support Services

Austin, TX · Healthcare
About the Company: 
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals.  Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).  

The Company operates local health plans and offers a range of health insurance solutions.  It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.


Position Overview:
Oversee the operation of the Contract Implementation Analyst and Claims Liaison teams


Responsibilities: 
  • Oversee the claims operation function, including contracting and configuration
  • Monitor staff performance to identify any process or quality gaps and develop/implement business solutions to correct issues
  • Provide management with necessary data to expedite resolution of claims issues and support in policy decisions related to claims operations
  • Serve as the subject matter expert in resolution of claims and configuration issues
  • Manage the health plan’s workflow to assure timely, accurate submission and implementation of contracts
  • Act as health plan interface on software product upgrades/implementations that affect contract implementation
  • Promote change through establishment and sharing of best practices
  • Interface with all organizational levels to mobilize commitment and ensure accurate configuration, contract implementation, and claims operations


Qualifications:
  • Bachelor’s degree in related field or equivalent experience.
  • 5+ years of provider relations/services, provider contracting and/or claims administration experience in a managed care environment.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
  • Experience with Medicare and Medicaid claims and contracting preferred.

Benefits: 
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions. 
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
  • Short- and long-term disability insurance
  • Basic Life insurance
  • Supplemental AD&D
  • Supplemental life insurance
  • Wellness Program
  • 401(k) retirement with company match
  • Employee stock purchase plan
  • Vacation, Personal and Sick time
  • Paid Company Holidays
  • Employee Assistance Program (EAP)
  • Training and Learning Opportunities
  • Tuition Reimbursement/Educational Assistance
  • Service Awards
  • 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
April A. Estes
ProEnlist, LLC
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Please do NOT email the recruiter.  Applications are only accepted via the apply link.
C2C Not Available for This Position




 
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