Director / Senior Director, Claims Operations


Washington, DC

Industry: Managed Care & Health Insurance


8 - 10 years

Posted 383 days ago

This job is no longer available.

Health Services for Children with Special Needs, Inc., (HSCSN) serves children and young adults up to age 26 who live in Washington, DC and receive  (SSI). We focus on young people with special health care needs. That way, we can give your child the kind of attention and level of care that helps make his or her life as full as possible.

HSCSN is one component of , a nonprofit health care organization committed to serving people with complex health care needs and eliminating barriers to health services.

The Director/Senior Director, Claims Operations is responsible for the day to day oversight of the Claims Operations department. The position will identify process improvements and implement short and long range goals, coordinate claims operations staff, enhance claims business development efforts, and continually focus on optimization in the areas of compliance, quality and reporting. The Director/Senior Director, Claims Operations is responsible for ensuring compliance with company policies, procedures, State and Federal regulatory requirements for all claims operations under their management. This position works closelywithother plan leadership to identify opportunities for innovation and operationalization of new ideas. 

Minimum Experience Requirement: Minimum seven (7) years’ experience in health care managed care operations required. In-depth knowledge of ICD-10 and CPT coding. Must be a high-energy, dynamic leader who enjoys mentoring and managing people. Excellent verbal and written communication skills and the ability to effectively collaboratewithother departments in the successful resolution of operational issues. Strong leadership skills in the areas of staff development, performance improvement with demonstrated results. Ability to foster a cohesive working environment. Must be proficient in Microsoft Word, Excel and Outlook. Minimum of three (3) years’ experience in leading claims department. Subject matter expertise and familiarity with Medicare and Medicaid requirements for encounters and full compliance. Extensive knowledge of all claims operations and medical claims processing – professional, pharmacy, and facility claims. Familiarity with IT and claims specific systems (e.g. Trizetto). Specific experience dealing with Medicaid and Medicare Advantage Plans claims processing. 

Minimum Education Requirement: Bachelor’s degreepreferred. Master’s degreepreferred. Equivalent management experiencewith financing and claims may be considered.