Needs Manger (Remote, US)

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Requirements:

• 2+ years of management experience required.
• 3+ years of experience in Needs and/or claims processing for traditional and Healthshare plans required.
• Strong understanding of general claims processing principles.
• Knowledge of CMS coding, UB-04 claims coding, CPT, HCPCS, dental and diagnosis coding.
• Excellent data entry, analytical, and problem-solving skills.
• Ability to interpret and apply benefits based on specific plan guidelines.
• Strong attention to detail and accuracy.
• Proficiency in claims processing software and systems.
• Ability to work independently and in a team environment.
• Strong organizational skills to manage multiple tasks and deadlines.
• Familiarity with healthcare regulations and compliance requirements.
• Strong customer service skills.
• Excellent verbal and written communication skills.
• Legally authorized to work in the US.

Responsibilities:

• Accurately adjudicate CMS 1500 and UB-04 Needs for Healthshare plans.
• Review medical documentation to determine shareability under the Healthshare plan.
• Conduct audits to ensure accuracy and compliance.
• Research and process complex Needs.
• Engage in outreach to gather necessary documentation.
• Provide new and ongoing staff training.
• Manage daily operations of the Needs staff.
• Develop and maintain processing policies and procedures.
• Recalculate Needs as needed.
• Investigate and resolve discrepancies promptly.
• Stay updated on industry standards and regulations.
• Document actions in the processing system.
• Collaborate to enhance efficiency and streamline processes.
• Lead training sessions for staff updates.