Overview
Oversees the efficient and accurate processing of claims, resolution of payment disputes, and implementation of claims quality improvement initiatives. This role is critical in ensuring financial integrity, compliance with regulatory requirements, and the delivery of exceptional provider experiences.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, including Medical, Dental, Vision, Life, and Disability
- Employer-matched retirement savings funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, CEU credits, and advancement opportunities
What You Will Do
Develop and oversee the claims payment dispute resolution process, including investigation, analysis, and resolution of complex claims issues.Manage a team responsible for identifying, researching, and resolving payment discrepancies, denials, and underpayments.Collaborate with internal and external stakeholders to resolve payment disputes promptly and effectively.Implement strategies to reduce claim errors and payment delays.Oversee day-to-day operations of the claims processing department, ensuring adherence to procedures and timelines.Monitor claims processing metrics and identify opportunities for process improvement.Ensure compliance with regulatory requirements related to claims processing and payment.Develop and implement a claims quality audit program to assess accuracy, completeness, and compliance.Identify trends and root causes of claim errors and develop corrective action plans.Monitor and report on claims quality metrics and performance indicators.Identify opportunities for claims recovery and cost savings through data analysis and process optimization.Develop and implement strategies to recover overpayments, prevent fraud, waste, and abuse.Collaborate with cross-functional teams to identify and implement affordability initiatives that impact claims costs.Monitor and report on claims recovery and affordability performance metrics.Perform managerial duties including staff training, hiring, promotions, terminations, salary actions, and performance evaluations. Participate in budget development and adherence.Participate in special projects and perform other duties as assigned.Qualifications
Education:
- Bachelor's Degree in healthcare administration, business, or related field required
Work Experience:
- Minimum of 5 years in healthcare claims processing, payment integrity, or related field
- Proven leadership and team management skills
- Experience with claims adjudication systems and data analysis tools
- Proficient in Microsoft Office, including Excel, Access, Word, and PowerPoint
- Effective written and oral communication skills
- Experience with healthcare information systems such as Facets, Salesforce (preferred)
- Knowledge of healthcare regulations and compliance (preferred)
- Strong problem-solving and analytical skills
Compensation
$98,200.00 - $130,800.00 annually
About Us
VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. With over 130 years of innovation in healthcare, we are committed to helping people live, age, and heal where they feel most comfortable—in their own homes, connected to family and community. Over 10,000 team members deliver compassionate care and 24/7 support to more than 43,000 neighbors daily. Powered by unmatched data analytics, we offer comprehensive health services, solutions, and plans to simplify healthcare and meet diverse community needs in New York and beyond.
#J-18808-Ljbffr