Robert Half Corporation Jobs

Description

Roseann Mabry is partnering with a growing organization to place a Medical Claims Team Leader for growing DME company in major growth mode. The Medical Claims Team Leader will be in a department of 18 people. You will have 6 direct reports handling claims. Your responsibility will be working the denials and appeals process. Must have ALJ experience to get an interview for the position. ALJ hearings will be done twice a month. The Medical Claims Team Leader will run the call. We are looking for that special Unicorn that has the ability to build a solid team, help create KPI's for this new business line, and be a Leader in the organization. The annual salary for the Medical Claims Team Leader will be up to 80K. Send your resume to Roseann Mabry at Robert Half. Look me up on Linked In!

Responsibilities:

• Supervising the claims procedure, ensuring accuracy and efficiency in DME. Must have ALS hearing experience.

• Handling the denials and appeals process, ensuring all cases are appropriately addressed.

• Leading and developing a team, fostering a supportive and productive environment.

• Conducting Administrative Law Judge (ALJ) hearings on a regular basis.

• Utilizing various software and systems including Allscripts and Cerner Technologies.

• Ensuring compliance with the regulations of Centers for Medicare & Medicaid Services (CMS).

• Overseeing the billing procedures, specifically related to Medicare Billing, Medicare Claim, Medicare Risk Adjustment, Medicare Supplements, and Medicare Advantage.

• Carrying out audits in the healthcare sector, with a focus on Medicare and Medicaid.

• Managing the usage and maintenance of Durable Medical Equipment (DME).

• Developing and tracking key performance indicators (KPIs) to measure the success and efficiency of the new business line.

• Administering the claim process for the organization, ensuring the smooth operation of all related functions.

Requirements

• Minimum of 5 years of experience in Medical Coding Auditing

• Experience managing a small team.

• Proficiency in medical coding software for healthcare management

• Experience with Armed Forces Health Longitudinal Technology Application (AHLTA)

• Familiarity with Cerner Technologies

• Strong auditing skills, particularly in the healthcare sector

• Experience with billing functions in a healthcare setting

• Ability to construct and interpret charts and graphs

• Knowledge of claim administration processes

• Understanding of the regulations of Centers for Medicare & Medicaid Services (CMS)

• Experience with Medicare Billing, Medicare Claim, Medicare Risk Adjustment, Medicare Supplements, and Medicare Advantage

• Familiarity with Health Care Audits for Medicare and Medicaid

• Experience with DME or Durable Medical Equipment

• Proficiency in KPI Reporting in a healthcare context

TalentMatch®

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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