Manager - Claims Auditing & COB - SHP

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title:

Manager

• Claims Auditing & COB - SHP

Cost Center:

682891379 SHP-Claims

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

40 Normal (United States of America)

Job Description:

JOB SUMMARY

The Manager

• Claims Auditing and COB - SHP is responsible for managing Claims Department auditing and COB staff and providing leadership for overall claims audit management and will manage a team responsible for audit functions of Claims Operations. Must remain current in the content areas that fall within the audit and COB department's responsibility.
  
  They will collaborate with other SHP areas for internal or external claim education, as needed. Act as a resource for personnel, both within and external to the claim department regarding all SHP product lines. Identify process improvement opportunities utilizing training and audit processes.
  
  Has overall responsibility for all day-to-day functions within the auditing & COB team, to include personnel actions within the team. Works closely with the VP of Operations to assure effective management of the Claims Audit & COB Department. This position will provide strategic planning and tactical activities supporting SHP annual objectives, strategic directions and goals.

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required: Bachelor's degree in education, business or a related field required, however, significant experience considered.

Business or medical background, including information systems knowledge, preferred. Medical Terminology, Anatomy & Physiology, CPT/HCPCS and ICD-9 coding are required. Intermediate level of Word, Excel and PowerPoint required, knowledge of Access.

Preferred/Optional: None

EXPERIENCE

Minimum Required: Minimum of 5 years in the health insurance industry required.

Minimum of three years technical experience (hands-on working knowledge) in health insurance claims. Must have strong analytical and problem-solving skills, a high level of creativity, and excellent oral and written communication skills.

Preferred/Optional: Prior experience in the management of health claims operations.

CERTIFICATIONS/LICENSES

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.

Minimum Required: None

Preferred/Optional: Certified Professional Coder.

Hybrid Remote Work Environment requiring 2-3 days onsite

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health.

We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid.

This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.