What are the responsibilities and job description for the National Director of Claims Management position at AIDS Healthcare Foundation?
WHO WE ARE
AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!
Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?
If so, AIDS Healthcare Foundation is the place for you!
Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.
AHF’s core values are:
• Patient-Centered
• Value Employees
• Respect for Diversity
• Nimble
• Fight for What’s Right
STILL INTERESTED? Please continue!
YOUR CONTRIBUTION TO OUR SUCCESS!
The Director of Claims Management (DCM) contributes to AHF by working in concert with the Chief of Care Management and Division Executive Management to set the strategic direction of the Claims Department and executes the tactics to achieve federal and state regulatory, grant, operational and accreditation compliance and service goals. The DCM further contributes to AHF success by assuring the claims management system and operational processes are compliant with various grant contracts, CA state MediCal and Department of Managed Care and federal CMS/Medicare regulatory and contractual requirements, and that the claims systems (e.g., RAM Technologies Health Suite) are updated timely, configured accurately and processes are well researched and documented in order to ensure accuracy of payment, maximize auto adjudication and staff knowledge and productivity.
The DCM enhances the reputation of AHF by developing and maintaining a best in class claims department that produces timely and accurate claim management results that meet customer, patient, regulatory contractual, accreditation, compliance, litigation and quality of service standards for accuracy, timeliness, financial management practices.
You will be a passionate advocate for our top initiatives.
To be successful as the DCM, it is crucial to ensure that the AHF Core Values and Mission stay top of mind with all that you do. At AHF, we are nimble and able to adapt in a dynamic environment to assist in providing the best experience for our clients and workplace for our employees.
AHF has a collaborative organizational structure where staff are accountable to multiple leaders.
The DCM will work as a part of a close-knit team to deliver a positive experience and outcome to medical providers, patients, various state Grantee Offices, allied health vendors and staff. The DCM leads as the subject matter expert on claims payment and process flow and accurate encounter data, as well as leading the department in internal audits, partnering with Compliance and Finance to ensure smooth and organized external local, state, and federal audits and addressing any findings in audits in a well planned and executed corrective action and follow up. The DCM develops, monitors, documents and reports key measurements, trends and operational issues to leadership in a timely manner .
INDAHF
AHF Commitment
We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment. AHF will consider qualified applicants with criminal histories in a manner consistent with the requirements of the ordinance.
