What are the responsibilities and job description for the Claims Manager position at Viva Health?
Claims Manager
Location: Birmingham, AL
Work Schedule: Hybrid schedule with regular work onsite at the VIVA HEALTH corporate office and some work-from-home opportunities.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Healthcare Reimbursement Account
- Paid Parental Leave
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
- Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Claims Manager is responsible for providing the necessary leadership to ensure all claims functions and responsibilities are handled in accordance with regulatory compliance standards including the Centers for Medicare and Medicaid Services (CMS), the Department of Insurance (DOI), Evidence of Coverage (EOC), Certificates of Coverage (COC), etc.
This role ensures adherence to regulatory compliance guidelines, internal corporate, and department policies and procedures. This individual is accountable to ensure all aspects of work in preparation of audits is complete. The Claims Manager is responsible for managing team staff levels and makes necessary recommendations for staffing changes based on trends and analysis to ensure objectives are met.
Key Responsibilities
- Provide team leadership to ensure inventory and other functions of responsibility are performed in a high-quality manner and timeliness standards are met.
- Ensure benefits are administered based on regulatory compliance standards of CMS, DOI, EOC, COC, etc. during adjudication of claims.
- Encourage and promote a positive work environment by being a team player, providing leadership, and supervision to assigned staff. Successfully multi-task and be open to change. Encourage high quality and production standards in a manner that enhances morale and the productivity of employees.
- Interview, hire, and collaborate with the department trainer to ensure employees receive adequate training to perform essential job functions and have a clear understanding of processes and procedures.
- Identify error trends based on documented information received from Quality Assurance and other sources. Ensure affected employees are re-educated and provided coaching as needed.
- Ensure steady queue workflow of claims processing. Monitor staffing and provide staffing recommendations to the department leaders based on changes in inventory levels ensuring department and team goals be met.
- Create and update policies and procedures ensuring employees have access to the most current versions to allow quality performance with essential job functions.
- Provide reporting and data analysis as required and as requested by management. Provide work efficiencies recommendations for internal and external departments. Strive to resolve issues as they arise. Alert department leadership of escalated issues and offer recommendations to resolve the issues.
REQUIRED:
- Bachelor’s Degree or 4 years’ experience in a supervisory or management position
- 5 years’ experience with adjudication of HCFA/UB claims
- Knowledge of regulatory and accrediting agency guidelines, HIPPA laws, and regulations
- Knowledge of ICD9-10, HCPCS and CPT4 coding, HCFA uniform billing codes, and coordination of benefit remark codes
- Ability to work with internal and external auditors to ensure completion of audits
- Ability to manage workflow to meet and maintain goals, multi-task, and oversee multiple projects while simultaneously being open to the many changes that have the potential to occur in the department
- Highly motivated, goal oriented, and willing to work over and above a 40-hour week to satisfy department needs
- Ability to exercise confidentiality, discretion, diplomacy, and professionalism with interpersonal and conflict management skills
- Proficient in Medical Terminology
- Proficient in Microsoft Word, Excel, PowerPoint, etc.
- Ability to communicate effectively verbally and in writing
PREFERRED:
- Knowledge of PowerSTEPP, auditing knowledge
