Claims Manager, Managed Care

Denver Health Denver , CO 80208

Posted 6 days ago

Job Summary

Maintains supervision of the day to day claims processing function for the Denver Health Medical Plan. Trains claims business analysts to ensure accurate processing of claims.

Educates regarding subrogation and coordination of benefits. Reviews claims adjudication for timeliness and accuracy of payment. Educates claims business analysts regarding contract terms.

Interfaces with other personnel within the Managed Care Division to assist with extraction of accurate claim information for reporting purposes. Interfaces with Managed Care Information Systems regarding system changes and data extraction.

Minimum Qualifications

Education 1. Bachelor's degree required.

Experience 1. Five years of health care claims experience required. 2.

Experience in Medicaid, Medicare, and Commercial lines of business preferred. 3. Two years of lead or supervisory experience required.

Knowledge, Skills and Abilities 1. Fluent understanding of HCPC codes, UB 04 forms, HCFA 1500 forms, RBRVS fee schedules, and other common claim coding conventions. 2.

Understanding of NAIC coordination of benefit rules. 3. Excellent verbal and written communication skills. 4. Demonstration of good supervisory skills. 5.

Knowledge of general report writing. 6. Ability to work independently and collaboratively, generate creative ideas for interventions with other internal and external team members to ensure timelines are met

Computers and Technology 1. Proficient in Microsoft Suite

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment hasbeen made.

Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.

As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.

Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).

"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."



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Claims Manager, Managed Care

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