[ref. a57953324] Claims and Provider Reimbursements Manager - Nonprofit
AMI Network San Leandro
An incredible Health Plan / Medical Group is looking for a dynamic, experienced Claims Manager for their non-profit organization in San Leandro!
You will be working for a team that has incredibly skilled and adept leadership and most importantly a strategic vision to enable the organization to continue being an industry leader for the next decade. If you've ever thought about continuing your healthcare career with an fantastic and compassionate organization that thrives on a patient-first model, this is the role for you.
Comprised of eight federally qualified community health centers in Alameda County, the organization functions as the managed care MSO for eight health centers. With a strong mission of providing the best possible care to the community, the team is seeking for an individual who is savvy and experienced in the realm of Claims Management.This is an excellent opportunity for a Lead or Supervisor to move into a Management position!
RESPONSIBILITIES- Lead the claims team and payment program; develops subject matter expertise in the Medi-Cal benefit program to ensure that staff are able to appropriately and efficiently process claims to meet internal and regulatory standards.
- Work with providers and health plans in the healthcare safety net and embrace innovation and process improvement
- Ensure compliance with regulatory and health plan requirements related to provider reimbursement
- Engage with staff to reimagine and implement improved workflows using innovation and technology
- Utilize data and concrete metrics to monitor, evaluate, and improve reimbursement performance
- Oversees Claims Auditors, Examiners, Assistant, and Coder
- Ability to interpret Medi-Cal benefit rules and apply to provider reimbursement
- Payor side experience
- EZ-Cap experience is desirable
- One year experience supervising staff or leading teams
Final salary is per employer discretion and commensurate with experience.
San Francisco, 14 mi from San Leandro
Overview:
The Field Reimbursement Manager (FRM) will report to the Sr. Director of Field Reimbursement on the Market Access Team. The FRM will be primarily responsible for the overall reimbursement process which will require collaboration between...
RandstadMountain View (CA), 24 mi from San Leandro
interactions with many internal and external contacts as required for compliance, audits, and accuracy.
• Interacts with Manager, Director of Revenue & Reimbursement, Manager Charge Master, internal audit representatives, client relations, nurse auditors...
San Leandro
Overview:
ABOUT AMERICAN GOLF
American Golf is a distinguished leader and pioneer in the golf industry, renowned for its innovative and unparalleled approach to golf course management. With over 50 years of experience as an owner, lessee, and...