Most Loved Workplace® Certified JobClaims Manager, Medicare Advantage Plan (Flexible-Hybrid)
Most Loved Workplace® Certified JobAbout the Role
At UCLA Health, a Most Loved Workplace® certified employer in the Hospital & Health Care space, Healing humankind, one patient at a time, with world-class care and discovery..
Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence. The Claims Manager of the Medicare Advantage Plan will: Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments. Foster a positive, high-performing team culture focused on quality and exceptional customer service. Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures. Empower the team to navigate challenging scenarios with confidence and consistency.
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Requirements
- Bachelor’s degree in business, health care or a related field and/or equivalent work experience
- Five or more years of claims operations experience in a Medicare Advantage or related environment
- Three or more years of managing personnel in a claims processing environment
- In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
- Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.
- Knowledge of standard electronic and paper claim formats
- Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines
- Computer proficiency with Microsoft Office Suite and data visualization tools
- Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements
- Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
- Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)
- Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT
- Excellent problem identification, resolution, and analytical abilities
- Strong communication, interpersonal, and analytical skills
- Ability to develop, implement, and evaluate methods/systems to improve efficiency
- Ability to lead and facilitate cross-functional workgroups
- Proficiency in achieving compliance with regulatory requirements
- Ability to travel/attend off-site meetings and conferences
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View Original PostingWhy This Is a Most Loved Workplace® Certified Job
Systemic Collaboration
Our employees are challenged and empowered in an atmosphere of learning and support. Every day, we are able to make a significant difference for our patients, our community and our team members. We are committed to equity, inclusion and diversity. All employees have an opportunity to work alongside other world-class health care professionals and contribute to our reputation as an internationally-respected leader. Every day, we are able to make a significant difference for our patients, our community and our team members.
Positive Vision for the Future
There’s a sense of shared purpose that lets us know we’re in a true place of inclusive, compassionate healing. That’s the UCLA Health culture and it’s built on a clear mission, a focused vision and enduring values.
Alignment of Values
More than a visionary leader at UCLA Health, Johnese Spisso, CEO of the UCLA Hospital System, is active in community leadership and has served as the Los Angeles Community Chair for the Leukemia and Lymphoma Society Light the Night Walk as well as the Los Angeles Community Chair for the American Heart Association’s Go Red for Women Luncheon. She has received numerous awards and recognition throughout her career, including being named to Modern Healthcare’s Top 25 Most Influential Women Leaders in 2019, LA Business Journal’s 500 Most Influential Leaders in Los Angeles in 2020 and Modern Healthcare’s Top 50 Clinical Leaders of 2020 in the U.S.
Respect
UCLA Health champions the talent that unites our organization in serving our communities. We believe that every individual has a voice, and we welcome the difference those voices make in enhancing our world-class culture of healing humankind through acts of kindness.
Killer Outcomes
As members of the UCLA Health community, we are committed to the highest ethical standards to advance our mission of delivering leading-edge patient care, research and education. We all share the responsibility of conducting our professional and personal practices, following the principles of integrity, compassion, respect, teamwork, excellence, and discovery. We are committed to honoring the trust of our patients, families, and community by continuously striving to deliver exceptional care through excellence in quality, safety, service, affordability, and equity
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