Director, Claims Configuration

Centene   •  

Tempe, AZ

Industry: Healthcare IT

  •  

8 - 10 years

Posted 394 days ago

Description

 Position Purpose: Direct the strategic analysis and accuracy of Claims processes and oversee and ensure compliance with state regulations and/or provider contracts

  • Oversee the collection, validation and analysis of data to deliver business solutions ensuring claims payment accuracy, efficiency and quality
  • Monitor performance, evaluate, develop and implement business solutions to improve process and quality gaps
  • Identify improvement opportunities and promote change through sharing of best practices
  • Leverage automation to achieve desired results by reviewing and implementing new processes and technological tools
  • Perform claim adjudication project analysis and preparation work flow management
  • Coordinate the implementation of new product or health plan expansions
  • Formulate and establish policies, operating procedures and goals in compliance with internal and external guidelines
  • Oversee annual operating plan process and new business initiatives

Qualifications
Education/Experience: Bachelor's degree in a related area or equivalent experience. 7+ years of claim processing payer support services experience in a healthcare environment. Previous Medicaid experiencepreferred. Previous finance/budgetexperiencepreferred.

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