Job Description
We are excited to invite a talented and experienced Healthcare Claims Project Manager to join our dynamic consulting team. In this crucial role, you will report directly to the Program Director and have the opportunity to drive impactful projects while advancing your career. The ideal candidate will have a strong background in Medicare claims processing and a deep understanding of various healthcare claims payment practices, including payment audits, appeals, CMS rules and regulations, benefit configuration, coordination of benefits (COB), enrollment, and provider networks. Familiarity with key files used in enrollment and claims processing (such as 834, 835, 837) and general knowledge of file transfer processes are essential for success in this position.
Key Responsibilities:
Lead and manage healthcare projects related to claims processing and payment, ensuring successful outcomes.
Analyze Statements of Work (SOWs) and Requests for Proposals (RFPs) to uncover opportunities, conduct research, and develop cohesive implementation strategies.
Oversee project execution and collaborate with subcontractors to ensure compliance with client requirements.
Utilize Excel to manipulate and analyze medical claims data, employing pivot tables and other advanced techniques to identify trends and insights.
Manage project budgets effectively, ensuring resources are utilized efficiently while understanding the overall budget creation process.
Develop and implement strategies to enhance the efficiency and accuracy of claims processing.
Work closely with clients to understand their needs and deliver customized solutions.
Analyze claims data to identify trends, issues, gaps, and key focus areas for the project.
Ensure compliance with all relevant regulations and standards in the healthcare sector.
Collaborate with IT teams to oversee file transfers and maintain data integrity.
Provide training and support to clients and team members on claims processing and payment systems.
Prepare detailed reports and presentations for clients and stakeholders.
Monitor project progress and make adjustments as needed to meet deadlines and objectives.
Qualifications:
A minimum of 5 years of experience in healthcare claims processing and payment.
At least 3 years of experience leading and managing programs involving 3 or more full-time resources with a total budget of $4M or more.
Familiarity with multiple claims payment systems that support end-to-end claims processing.
Strong understanding of various claims processing files and file transfer processes.
Excellent project management skills, with a proven track record of managing complex healthcare projects.
Strong analytical and independent problem-solving abilities, particularly in a remote work environment.
Exceptional communication and interpersonal skills, with the ability to thrive in a collaborative setting.
Proficiency in relevant software and tools (e.g., Excel, MS Planner, MS Project, EncoderPro, Codify, SharePoint, Salesforce).
Ability to work independently as well as collaboratively within a team.
Preferred Skills:
Experience in a healthcare consulting environment focused on government programs.
Knowledge of healthcare regulations and standards.
Familiarity with claims related to Medicaid, TRICARE, and group health plans is a plus.
Management and leadership experience with direct or indirect reports involved in claims or record review.
Experience with state or federal contracts and engagement with government stakeholders.
Certification in project management (e.g., PMP, PRINCE2) is desirable.
Employment Type: Full-Time
Salary: $ 49,000.00 122,000.00 Per Year
Job Tags
Full time, For subcontractor,