Medical Claims Account Manager

Job Title: Medical Claims Account Manager

Reports To: CFO

FLSA Status: Exempt

Summary: Delivers dedicated and loyal client service and provides oversight of the contractual agreements with specific clients such as state agencies, including departments of public health and insurance departments, program board of directors, and other contractually designated parties. Will perform administrative tasks related to client health premiums and medical out of pocket expenses, interact with clients to provide information in response to inquiries about products and services, handle and resolve complaints.

Duties and Responsibilities include the following. Other duties may be assigned.

• Maintains overall knowledge of program, client’s goals and requirements with complete understanding of the program’s operational systems with focus on the system’s ability to produce statistics and information for clients and internal staff. *
• Acts as a coordinator to assemble entire reports or responses to clients. *
• Establishes strong positive client relationships by maintaining a trusting, open, and professional rapport both with external and internal clients. Serves as a liaison between the client and PAI on many occasions. *
• Provides timely response or follow up to questions from both external and internal clients. *
• Acts as primary point of contact and communicator with the client during normal business hours. *
• Serves as the group facilitator or meeting leader for the assigned program meetings and conference calls. *
• Interacts with the customer service team leaders and insurance benefits manager, provides guidance on various issues. *
• Conducts quality assurance checks to ensure that SLAs are achieved and that meaningful and accurate reports are being provided to external and internal customers. *
• Reviews assigned contract on a monthly basis to ensure obligations are met including: reviewing each deliverable and procedure in the contract, identifying key areas of adherence, maintaining contract compliance, keeping track of renewal dates, and alerting senior management and chief executive office 60 days prior to the contract expiration. *
• Strong ability to read EOBs and healthcare terminology. *
• Process or adjust medical insurance claims and appeals in accordance with policies and procedures. *
• Create an update financial batch records for processing by finance. *
• Manage day to day workflow of the team and promote team work and service deliver success. *
• Identify research and resolve claim issues. Request for additional documentation. *
• Recommend process improvements. *

• Medical Claims Requirements:
• Medical Coding and Billing Certification or equivalent related experience.
• Medical Claims Processing.
• Previous experience as a supervisor or manager.
• Familiar with medical claims clearinghouse.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Language Ability:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Math Ability:

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Computer Skills:

To perform this job successfully, an individual should have knowledge of word processing software, spreadsheet software, timekeeping software, internet software, database software, proprietary software, and Microsoft Office Suite.

Education/Experience:

Bachelor's degree (B. A. / B. S.) in Account Management from four-year college or university; or five years of demonstrated experience in account management; or equivalent combination of education and experience.

Knowledge, Skills, and Other Abilities:

• Project management skills
• Presentation skills
• Supervisory and leadership skills
• Ability to work efficiently, accurately, and independently to identify and resolve issues
• High level of attention to detail
• Excellent verbal and written communication skills
• Ability to establish and maintain open communications with clients
• Ability to work within deadlines
• Proven ability to perform follow-up with staff or external parties in order to adhere to deadlines
• Ability to analyze, prioritize, and recognize when to escalate issues to senior management
• Ability to make high-level decisions independently
• Ability to work independently with minimal to no guidance from management
• Proven ability to manage multiple projects at the same time while paying strict attention to detail
• Working knowledge of health insurance premiums and claims, the health insurance industry, government affairs, and subsidy administration
• Entrepreneurial spirit/mindset, flexibility, and tolerance for ambiguity
• Willing to work in a hands-on role to support both complex and fairly basic functional responsibilities
• Bi-lingual is not required, but is a plus
• Strong problem solving and creative skills
• Ability to exercise sound judgment and make decisions based on timely analyses
• Excellent customer service skills
• Experience in delivering client-focused solutions based on customer needs
• Financial aptitude is a plus
• Ability to learn new data programs and data applications is also a plus

The above is intended to provide general guidance regarding the responsibilities of the position. It is not intended to be an all-encompassing definition of what the position entails and may be changed at the discretion of Senior Management at any time.

PAI is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law.

Job Type: Full-time

Pay: From $85,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Holidays
• Monday to Friday

Work Location: In person

Salary : $85,000