Assistant Director of Claims

Cascade Comprehensive Care Inc

  • Klamath Falls, OR
  • Permanent
  • Full-time
  • 26 days ago
  • Apply easily
SUMMARYThe Assistant Director of Claims is a member of the Operations management team and will provide direct leadership assistance to the Director of Operations with overall accountability for performance of the Claims department. This position is also responsible for leveraging technology to enhance claims related activities and build on department efficiencies. This role will be responsible for assisting in the strategic and operational planning for areas of responsibility. This will include business processes, key performance metrics, goal setting, collaboration, and project management, striving for operational excellence. This position is also responsible for achieving operational and enterprise goals related to the departments managed in relation to contractual and regulatory requirements and ensures efficient operations and processes while providing exceptional and consistent service to members and providers by performing the following duties.
  • Provides operational and strategic leadership to the Claims department and ensures optimal performance in the areas of budget, internal quality control, key performance indicators, efficiency, and initiatives.
  • Implements and maintains efficient claims adjudication processes that effectively utilizes technology to automate and maximize the accuracy of claim payments.
  • Oversees the end-to-end claims lifecycle, ensuring compliance with federal and state regulations.
  • Develops collaborative relationships with providers and other stakeholders with a focus on enhancing the service provided to members
  • Assists in directing and validating appropriate productivity, engagement and performance metrics are established and met, and ensuring department goals and KPI progress are routinely communicated to the organization's leadership team, key partners and throughout the organization, as applicable.
  • Oversees the development and monitoring of provider enrollment, billing, and claims processing policies and procedures.
  • Ensures the Claims department has the proper technology and operational systems in place and assists with implementation of system upgrades when necessary.
  • Conducts provider outreach and works to identify and resolve any payment or billing issues and maintains strong relationships with providers and vendors.
  • Monitors claims inventory, turnaround times, quality metrics, and analyzes claims data to identify trends, cost drivers, and opportunities for continuous improvement.
  • Ensures compliance with federal and state regulatory and contractual requirements, ensures policies and procedures are established and maintained to ensure efficient and compliant operations.
  • Collaborates with various departments in the organization to resolve complex claims issues and support audits.
  • Works with various departments in the organization and vendors to maintain and enhance claims systems and automation tools.
  • Serves as a subject matter expert on claims adjudication, enrollment, disenrollment, coding, fee schedules and reimbursement methodologies.
  • Oversees the implementation and optimization of workforce management tools for resource planning and balancing.
  • Participates in the strategic planning and goal-setting process for the organization.
  • Develops, manages, and cultivates relationships with government agencies, local community partners, institutions, and organizations to promote the organization's mission.
  • Maintains confidentiality and complies with HIPAA rules and regulations.
  • Maintains punctual, regular and predictable attendance.
  • Works collaboratively in a team environment with a spirit of cooperation.
  • Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.
  • Respectfully takes direction from manager.
EDUCATION and/or EXPERIENCEBachelor's degree from four-year college or university is required; and four to six years related experience and/or training; or equivalent combination of education and experience.COMPUTER SKILLSJob requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.Background Check & Drug Screen Required

Cascade Comprehensive Care Inc