Manager, Claims Operations (Remote)

tango is a leader in the home care health management industry and is preparing for significant growth!

We are hiring a Claims Operations Manager to join our team.

The Claims Operations Manager is responsible for coordinating work of subordinate employees engaged in medical billing, medical claims payment activities, customer service call center and claims reporting.  The Claims Operations Manager is responsible for ensuring accuracy and compliance with claims policies and procedures, SLA are met, report key metrics internally/externally, and bringing the concerns of claims billing to the attention of tango’s Claim Leadership.  

This job is ideal for someone who is dependable, adaptable, and flexible, who enjoys doing work that requires a face pace, frequent shifts in direction, detail-oriented, achievement-oriented, taking on challenges, even if they might fail, and someone who is autonomous and independent.

Responsibilities: 

• Establish and maintain relationships with other departments that have visibility to claims
• Serves as the primary point of contact for internal and external stakeholders regarding claims, addressing inquiries, concerns and providing education about claims processes, timeliness and potential follow up
• Oversight of provider/payor customer service and provider education.
• Evaluate/monitor all data integrity and escalate to leadership when risks are identified.
• Monitor effectiveness by performing technical analysis to track/trend bugs/manual work arounds to recommend enhancements and improve ROI
• Ensure compliance with regulatory guidelines is met by maintaining automated processes to mitigate risk (Medicare CMS, Federal/State Laws etc.)
• Responsible for the recruitment, retention, and development of claims staff
• Oversee claims operations performance including paper & electronic claims receiving, processing, adjudication, payment/denial and EOP to providers
• Oversees Encounter file transmissions including EBT, DPT reporting and handling of rejections in the contractual required time frame
• Identify opportunities for improving processes to improve productivity and quality.

Qualifications:

• Bachelor’s degree in business, Healthcare Administration or a related field
• Deep knowledge in Medicaid EVV including encounter transmissions highly preferred
• Knowledge of medical reimbursement methodologies and terminology
• Excellent written and verbal communication skills
• Knowledge of 835/837 reporting (Preferred)

Essential Skills:

• Excellent interpersonal, communication and organizational skills
• Excellent knowledge of claims reporting based on Service Level Agreements (SLA) and Medicare CMS requirements
• Excellent planning, organizing, and managing skills with claims operations department employees & supervisors
• Ensure customer needs are identified, monitored, and practices modified to maximize customer satisfaction within established standards
• Motivate, facilitate, mentor and coach subordinates to deliver high-quality, cost-effective services
• Strong technical/system skills preferred-intermediate knowledge of Microsoft Office suites, including Power BI

Experience:

• 5 + years of progressively responsible supervisory experience
• 10+ years in claims processing and or billing

Physical Requirements:

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to access and navigate each department at the organization's facilities.
• Must be able to host Provider Webinars and Training and participate in Payor Audits

Job Type:

• Full-time
• Remote, willing to travel to AZ office quarterly

Compensation: TBD

Benefits: TBD

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.