Specialty Care Management (SCM) is a national company specializing in the management of healthcare and the associated financial risk of catastrophic diagnoses, including renal disease, cancer, transplants, high-risk maternity/neonate, and others. SCM is in need of a dynamic, innovative Claims Business Manager to be part of our Operations Department. We are a privately owned company in the self-funded marketplace and have been in business for 14 years.
Our Claims Business Manager performs a multi-facet of duties and is an integral part of the operations and accounting team. This position will have day-to-day responsibility for all aspects of the claims process; assisting with customer service; maintaining financial reports, records, and general ledgers, and perform general bookkeeping, such as accounts payable and accounts receivable. Additional duties include communicating with clients via telephone, email or regular mail; managing database records; drafting status reports on customer service issues, and managing the day-to-day operations of the office.
This position calls for frequent interaction with clients, providing information to Third Party Administrators, employer groups, brokers, and stop-loss carriers regarding claim status, reporting, and accounting matters. Familiarity with medical terminology, claims management, and filing procedures are often required. Sensitivity to confidential matters is required. This position will also be responsible for auditing, reporting, filing, and communication regarding SCM products both internally with other departments and externally with clients. The Claims Business Manager will also support executive leadership by providing reporting, data analysis, and process improvements for managing workflow.
- Review and process dialysis, transplant and/or hospital claims within the established turn-around time and quality standards of the department.
- Research and complete all correspondence related to electronic and paper claims assigned.
- Knowledge of ICD-9/ICD-10, CPT, and HCPCS coding systems. Requires knowledge of medical terminology and abbreviations, solid attention to detail, and sensitivity to confidential information.
- Organize and maintain client and patient files and records.
- Obtain additional information from providers and members when necessary.
- Maintain current knowledge of assigned Plan(s) and client contracts; effectively apply knowledge in the repricing and billing of claims, and in providing customer service assistance.
- Prepare documentation/collection notes for monthly accounts receivable reviews with COO and communicate with client accounting contacts.
- Provide assistance and support as needed in the billing and collections function and transitional planning.
- Maintain ongoing metrics for the executive management to provide continual self-assessment of performance and identification of process improvement opportunities.
- Manage the day-to-day operations of the office.
- Bachelor’s degree with a concentration in business, accounting, or healthcare (or equivalent combination of education and experience) is preferred.
- A solid background in claims processing in the insurance or TPA industry.
- Knowledge and understanding of medical coding and terminology.
- Prior experience in Taft-Hartley trust administration preferred.
- Excellent operational management skills, both technical and interpersonal.
- Strong leadership skills.
- Thorough understanding of claims operations to include payment of claims, interpretation of contracts, automated claims administration, etc…
- Intermediate to advanced PC skills, including Microsoft Word, Excel, and PowerPoint.
- Demonstrate strong organizational, analytical, and decision-making skills.
- Demonstrate strong communication, project management, and presentation skills.
Corporate Core Values
Specialty Care Management believes in delivering superior value to our many clients in the self-fund market by combining innovative products and competitive rates with superior service. If you would like to learn more about our organization, please E-mail your resume, cover letter, and salary history to firstname.lastname@example.org. Faxed resumes are welcome at 267-544-0642.