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Manager - Quality

Posted 4 months ago

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💎 Seniority level: Manager, 7 to 10 years

📍 Location: US

🔍 Industry: Healthcare

🗣️ Languages: English

⏳ Experience: 7 to 10 years

🪄 Skills: LeadershipProject ManagementData AnalysisPeople ManagementProject CoordinationHR ManagementCross-functional Team LeadershipOperations ManagementStrategyCommunication SkillsAnalytical SkillsCollaborationMicrosoft ExcelC (Programming language)

Requirements:
  • Graduate/Postgraduate in any field (preferably in Sciences).
  • 7 to 10 years of healthcare claims quality auditing experience.
  • 1 to 2 years of leading a team of 45+.
  • Thorough knowledge of medical terminology and claim processing procedures.
  • Experience with ICD9, ICD10, CPT coding systems is preferable.
  • 2-3 years of prior health care processing experience in Managed Care.
  • Effective oral and written communication skills.
Responsibilities:
  • Manages and supervises the Claims Team to ensure claims are paid properly and timely.
  • Identifies and addresses problem areas such as understaffing and customer complaints.
  • Coordinates and manages projects for department development.
  • Analyzes work processes and makes recommendations for improvements.
  • Handles all personnel-related duties including counseling, interviewing, and performance reviews.
  • Provides timely monthly reports on claims payment and inventory.
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