What are the responsibilities and job description for the Manager PACE Claims position at Franciscan Health?
WHO WE ARE
With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.
POSITION OVERVIEW
The Manager PACE Claims is responsible for overseeing and performing all functions within the claims adjudication process. As the leader of the claims processing team, this role drives accurate and timely payment of medical claims generated by PACE participants. The PACE program's vision is to provide individualized and joyful care through exemplary teamwork serving as many seniors as possible with the best quality-of-life in their communities.
WHAT YOU CAN EXPECT
Direct the PACE claims processing team in the performance of all aspects of timely and accurate claim adjudication.
Manage vendor experience through partnership lifecycle. Oversee customer service activities including support, education to vendors during onboarding phase of partnership, communicating claim statuses to vendors, investigating vendor inquiries, and processing claim appeals.
Oversee EDPS reporting, which includes reporting to regulatory agencies, clearing errors for resubmission of codes, and monthly auditing of EDPS return/output data.
Ensure claim processes are fully compliant with CMS requirements and updated Medicare guidelines, rates, and codes.
Maintain authorization rules that support efficient and accurate claims adjudication. Develop and maintain the vendor and provider network within the claims adjudication software. Ensure accuracy of vendor profiles in relation to reimbursement structure in vendor contracts, provider lists, W-9s, etc.
Maintain accurate participant eligibility record in claim adjudication software to drive accurate and compliant claim payments.
QUALIFICATIONS
Associate's Degree in Finance, Business, or Healthcare Administration - Required - OR -
Professional/Vocational/Trade Training with 3 years of claims experience in lieu of an Associates Degree - Required
Bachelor's Degree in Finance, Business, or Healthcare Administration - Preferred
3 years Medical Claims Management - Required
Certified Medical Reimbursements - American Medical Billing Association - Required or must obtain within 1 year of hire
TRAVEL IS REQUIRED:
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
Salary : $89,567 - $123,157
