Manager, PPO Claims Job at Altais
About Our Company
At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. Doctors today are faced with the reality of spending more time on administrative tasks than caring for patients. Physician burnout and fatigue are an epidemic, and the healthcare experience and quality suffer as a result. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve.
About Your Team
Are you looking to work with a high performing, fast growing and dynamic Operations team? Altais and our subsidiaries, form one of the most recognized medical groups in California. We are 3,000+ physicians, working in over 40 cities in California, caring for more than 350,000 patients. If working in a mission driven organization supporting highly competent, hard-working, thoughtful clinicians who value good ideas and are passionate about reshaping healthcare excites you, then we are thrilled to welcome you to your new career.
This position is located remotely (within the state of California). We are flexible provided you are open to traveling to the Oakland office locations as needed.
About Your Work
As the Manager, PPO Claims you will be responsible for overseeing the daily operations of the PPO Claim Team. The PPO Claim team is responsible for Revenue Cycle Management for all claim submissions in accordance to company policies, Health Plan submission regulations. Additionally, this role will be responsible to manage all PPO claim activities within the established timelines and accuracy objectives.
What You Will Focus On
- Lead and direct the daily activities of PPO claim processing staff, to include monitoring and tracking of individual and team performance against established productivity and quality metrics and assuring policy and procedures are adhered to and when necessary, modified to address changing strategic objectives
- Create, deploy, drive, and attain operational goals and objectives for the PPO Claim team and individual team members.
- Lead and direct all PPO claim processing, workflows and processes to ensure compliance with PPO Health Plan timelines and quality standards including overpayment recovery.
- Identify, recommend, and implement changes in company policy or work direction and implement changes within the PPO Claim team. Collaborate with other departments and administration to resolve interdepartmental issues.
- Responsible for, in partnership with Department Director, compiling, analyzing and submitting daily, weekly, and monthly departmental reports and metrics to management.
- Leading and partnering across the organization to ensure Key Performance objectives are met.
The Skills, Experience & Education You Bring
- Bachelor’s degree and/or 5 years of equivalent claim management/revenue cycle management experience required.
- Five years’ claim and/or revenue cycle management experience in Managed Care and/or PPO related setting.
- Two years’ experience leading in a supervisory capacity, to include hiring, work assignments, training, and staff performance management.
- Two years’ experience with designing and improving claim and/or revenue cycle management improving processing workflows and standing up accompanying operating and technical procedures.
- Two years’ experience working in EPIC Resolute.
- Demonstrated expert knowledge of full Revenue Cycle Management specific to PPO Product claims.
- Demonstrated strong computer skills including Microsoft Office (Word, Outlook, Excel, PowerPoint)
- Demonstrated strong oral and written communication skills, professional approach to problem resolution, strong organizational and decision-making skills with ability to prioritize projects.
- Demonstrated advanced knowledge of EPIC Resolute revenue cycle claim system, to include claim AR functions and design and work queue management.
- Demonstrated strong ability to be creative, problem-solving and innovation skills which include development of operational strategies that maximizes PPO claim workflow efficiencies and ensures consistent processes in alignment with our Health Plan Partners process.
- Demonstrated strong ability of independent decision-making skills and demonstrated ability to take initiative to resolve issues.
- Two years’ experience with managing a remote workforce preferred.
Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
Altais is a leading network of independent doctors focused on delivering personalized and high-quality health care in over 40 cities in California. Its network of more than 3,000 physicians, serving more than 355,000 HMO, ACO and PPO patients, is dedicated to improving care and reducing costs through innovative care management and care coordination programs, use of health care technology, and population health management strategies. For more than 30 years, Altais and its family of companies has proudly collaborated with leading hospitals and health plan providers to provide high quality care in California
Please note that Brown & Toland Physicians is a wholly owned subsidiary of Altais Clinical Services, a division of Altais. Other subsidiaries in the Altais family of companies include Altais Medical Group Riverside and Family Care Specialists Medical Group.
If you would like to search for other open positions within the Altais family of companies, please view the links below:
- Altais (https://altais.com/join-us/)
- Altais Medical Group Riverside (https://altais.com/altais-medical-group-riverside/employment-opportunities/)
- Family Care Specialists Medical Group (http://fcsmg.org/employment-opportunities/)
Please Note :
ajayjain.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, ajayjain.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.