Executive Director, Claims

Company: West Park Hospital-WY-US
Location: San Antonio
Posted on: July 1, 2020

Job Description:

We're looking for a candidate to fill this position in an exciting company. Governs and assumes accountability for the execution and monitoring of medical and long-term services and supports (LTSS) claims processing, inventory, and adjustments. Directs all claims activities and ensures claims department efficiency and claims payment accuracy. Demonstrates performance and process improvement by monitoring key metrics for the department, proactively identifies issues and improvement opportunities, and conducts frequent report-outs to company leadership. Complies with and enforces company departmental policies and procedures. Actively uses and understands company's claims adjudication system and all systems that interface with it. Bachelor's degree in Business, Health Care or Hospital Management or equivalent experience is required. Master's degree is preferred. Minimum of five years' experience in insurance, medical or managed care environment including two years of claim processing experience required. Requires prior leadership experience managing claims departments in the health insurance industry for commercial, Medicaid, and Medicare programs. Experience with QNXT and/or Epic Tapestry claims adjudication systems is strongly preferred. Previous auditing experience preferred. Experience with HEDIS, CMS, and NCQA is preferred. Experience working with Texas Department of Insurance and Texas Health and Human Services Commission (HHSC) is preferred. Experience with LTSS claims is preferred.

Keywords: West Park Hospital-WY-US, San Antonio , Executive Director, Claims, Executive , San Antonio, Texas