DirectorSr. Director Claims
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Job Location:
Monterey Park, NM - USA
Yearly Salary:
$ 150000 - 180000
Posted on:
16 days ago
Vacancies:
1 Vacancy
Job Summary
The Director - Claims will be responsible for overseeing the end-to-end claims management process ensuring accuracy efficiency and compliance with regulatory standards. This role involves leading a team of claims professionals optimizing workflows and driving strategic initiatives to improve claims operations. The ideal candidate is an experienced leader with a deep understanding of healthcare claims payer-provider relationships and a commitment to delivering exceptional service.
Our Values:
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What Youll Do
Leadership & Strategy
- Provide strategic direction for the claims department aligning operations with company goals and regulatory requirements
- Lead mentor and develop a high-performing claims management team
- Collaborate with executive leadership to establish and achieve claims-related KPIs and financial targets
- Identify the root cause of any operational weaknesses and implement the best solution
- Serve as a thought partner to internal and external stakeholders to achieve mutual goals
Claims Management Operations
- Oversee end-to-end claims operations claims processing adjudication and resolution to ensure timeliness accuracy and compliance
- Develop implement review dashboards reports policies procedures and workflows to optimize efficiency and mitigate errors
- Team accountability for areas such as timeliness reporting to the health plans encounter reports weekly inventory and workflow reports and IPA claims summary report for board meetings
- Monitor and address claim denial trends providing actionable insights and corrective strategies
- Manage relationships with payers third-party administrators and other key stakeholders
Compliance & Reporting
- Ensure compliance with state federal and industry regulations including HIPAA and CMS guidelines
- Prepare and present regular reports on claims performance trends and department metrics
- Conduct audits and reviews to maintain high standards of accuracy and compliance
Qualifications
- Bachelors degree in healthcare administration business or a related field
- 8 years of progressive responsibility preferably in a managed care setting Knowledge of DMHC DHS and CMS regulations and guidelines Proficient in knowledge of CPT HCPCS ICD-10 Strong knowledge of MSO operations healthcare reimbursement models and payer/provider dynamics
- Expertise in claims processing systems and technologies (e.g. EHR claims adjudication software) In-depth understanding of healthcare regulations including HIPAA and CMS guidelines
- Prior experience working in managed care/IPA setting
Youre great for the role if:
- You have a masters degree
- Have EZ-CAP software experience
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park CA 91754.
- The national target pay range for this role is $150000 - $180000. Actual compensation will be determined based on geographic location (current or future) experience and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race religion color national origin gender (including pregnancy childbirth or related medical conditions) sexual orientation gender identity gender expression age status as a protected veteran status as an individual with a disability or other applicable legally protected characteristics. All employment is decided on the basis of qualifications merit and business need. If you require assistance in applying for open positions due to a disability please email us at to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Required Experience:
Exec
