Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

Claims Manager Of The Medicare Advantage PlanWork Location: Los Angeles, CA, USAOnsite or remote flexible hybrid work schedule Monday - Friday, 8:00am-5:00pm PSTSalary Range: $98200 - AnnuallyEmployment Type 2 - Staff: Career Duration IndefinitePrimary Duties And ResponsibilitiesPlay 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 serviceIdentify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating proceduresEmpower the team to navigate challenging scenarios with confidence and consistencySalary Range: $95,400 - $208,300/annuallyNote: This position is flexible-hybrid.Job QualificationsWe're seeking a self-motivated, service-driven leader with:Required:Bachelor's degree in business, health care or a related field and/or equivalent work experienceFive or more years of claims operations experience in a Medicare Advantage or related environmentThree or more years of managing personnel in a claims processing environmentIn-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS codingUnderstanding of provider network/IPA arrangements and reimbursement methodologies, etc.Knowledge of standard electronic and paper claim formatsFamiliarity with AMA and Centers for Medicare and Medicaid Services coding guidelinesComputer proficiency with Microsoft Office Suite and data visualization toolsKnowledge of HIPAA, DMHC, AB1455, and CMS reporting requirementsBackground 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, QNXTExcellent problem identification, resolution, and analytical abilitiesStrong communication, interpersonal, and analytical skillsAbility to develop, implement, and evaluate methods/systems to improve efficiencyAbility to lead and facilitate cross-functional workgroupsProficiency in achieving compliance with regulatory requirementsAbility to travel/attend off-site meetings and conferencesPreferred:Certified Professional Biller (CPB)Certified Revenue Cycle Representative (CRCR)