"Lighting a Path to the Future"

Director, Claims | Contract Support Services

Location: Columbus, OH
Job Type: Direct Hire
Degree: Bachelor;
Date: 9/25/2017
Job ID: 02523559
Job Description
Director, Claims | Contract Support Services – Columbus, OH


Positive, collaborative culture and an exceptional mentor make this a very attractive opportunity in OHIO.  Unlimited career potential here- and our client will provide you with an excellent relocation package.


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


Ideal Candidate Profile:
- Bachelor's degree in a related area or equivalent experience.
- MUST have 7+ years of claim processing payer support services experience in a health plan/MCO/health plan environment


Preferred:
 Previous Medicaid experience
- Previous finance/budget experience
- System Configuration experience and AMYSIS experience are a plus
 
 

 




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