Manager Claims Admin - Revenue Cycle Claims Processing - Sharp Corporate - Day Shift - Full Time

Shift: 8 AM – 5 PM, 8-hour shifts, Monday–Friday (no weekends or on-call).

Pay

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position: $51.38 – $66.30 – $81.22 per hour. Actual pay rate and pay grade will depend on years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, and employer business practices.

What You Will Do

• Manage the claims units for Sharp Managed Care Contracts, including claims for Sharp Rees-Stealy, Sharp Community Medical Group, EOHD, Clinical Trials, and Transplant services paid by Sharp HealthCare.
• Ensure prompt, accurate, and efficient processing of claims.

Responsibilities

• Leadership
  • Display professionalism and teamwork in promoting the Mission, Goals, and Objectives of Sharp Healthcare.
  • Recruit, hire, and motivate staff to perform at a level that consistently meets expectations.
  • Develop, train, counsel staff, and conduct performance appraisals (standard: employee turnover rate kept at or below corporate standard; complete performance appraisals in a timely manner 98% of the time).
• Daily Operations
  • Maintain claim turnaround times at 95% processed within four weeks, 95% of the time, and accuracy rates of 95% procedural and 98% financial.
  • Develop reporting and follow-through mechanisms to document departmental efficiency and productivity.
  • Responsible for the development and implementation of continuous quality improvement and measurement of claims unit effectiveness.
• Training
  • Coordinate continuing staff training and establish quality and productivity standards to be reported monthly.
  • Provide input into claims policy and procedure manuals.
  • Effectively communicate departmental policies to staff and other affected areas.
• Application Management
  • Participate in the development and implementation of improvements in software functionality, workflow, and system integration.
• Internal and External Customer Service
  • Interface with Health Plans, Providers, Members, and Medical Groups to resolve issues in a professional manner that maintains consistently positive relationships.
  • Demonstrate a positive, professional, and contributory posture in all matters requiring interface with customers, both internal and external (standard: consistent positive feedback from staff, peers, and external customers; less than 2 exceptions noted per year).
• Safety
  • Demonstrate safe work practices by identifying and reporting potential safety hazards to appropriate personnel, including assuring staff’s appropriate chair height, keyboard and screen placement, securing of electrical wiring, and use of proper body mechanics.
  • Attend annual Safety Fair (standard: 1 exception noted per year and attends annual Safety Fair).

Requirements

• 3 years’ experience in the HMO industry to include claims, customer service, and/or health insurance management.
• 2 years’ leadership experience.
• Bachelor’s degree in business, health services, management, or relevant field; or 4 years of relevant experience in the healthcare industry may substitute for the degree.

Preferred Qualifications

• Experience with EPIC Tapestry.

Skills

• Knowledge of health insurance or HMO operations with emphasis on claims.
• Excellent organizational and interpersonal skills.
• Ability to work effectively as a member of a creative management team.
• Adept at being an initiator of positive change to support the Mission, Values, and Goals of Sharp Healthcare.
• Excellent analytical skills and understanding of database management.
• Knowledge of claims coding system, claims auditing techniques, and claim software functionalities.