Claims Director (20-02875) - CA - Alhambra
at RCM Health Care Services

Date Posted: 7/24/2020

Job Description

Claims Director
Pasadena, CA

Company Info:
  • Leading managed care organization serving Medicare and Medi-Cal populations in Southern California
    Position Details:
  • Responsible for the operations and performance of Claims Department.
  • Maintain consistent compliance in all aspect of claims operations.
  • Collaborate with other stakeholders in developing process improvements as they relate to claims payment accuracy and timeliness.
  • Provide direct support and leadership to the management and staff of Claims.
  • Develop processes and/or systems as they relate to the department and company's initiatives/programs and/or regulatory changes/requirements.
  • Interact with other departments to define project parameters such as claim auto adjudication improvements and regulatory report requirements.
  • Ensure compliance in all areas of operations such as accurate and timely processing of claims.
  • Develop and implement policies and procedures as they relate to claims operations.
  • Analyze, design and manage project workflow processes, timeframes and resources.
  • Oversee the development and improvements of claims related projects to ensure compliance and accuracy.
  • Stay abreast on all regulatory and/or contractual changes, communicates changes to appropriate staff and department.
  • Develop reports as required by Senior Management and regulatory agencies.
    Qualifications:
  • Bachelor's Degree; Master's Degree preferred
  • 4+ years management experience, ideally in managed care environment
  • Knowledge of different regulatory requirements
  • Expertise on medical claims systems platforms, preferably Power MHC
    Compensation:

    Competitive - Based on experience
    Full Medical Benefits (Free for Employee!) + PTO Package

Job Snapshot

  • Employee Type: Contractor
  • Location: Alhambra, CA
  • Job Type: Management
  • Experience: Not Specified
  • Date Posted: 7/24/2020

About Us

RCM Health Care Services offers career defining opportunities to candidates from the leading employers in health care. Whether you’re looking for a new job or seeking to hire the best medical talent, RCM Health Care Services has the solution for you. Since 1975, we’ve established ourselves as a leader in the recruitment industry by connecting thousands of healthcare professionals with placements that support their needs. If you’re looking to make the next move in your career, let RCM be your guide, we’re with you every step of the way!

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