Claims Manager

<strong>At CoreCivic, our employees are driven by service, professionalism and a responsibility to better the public good.</strong>

Brentwood, TN

CoreCivic

<p><strong>CoreCivic is a diversified, government-solutions company with the scale and experience needed to solve tough government challenges in cost-effective ways. We provide a broad range of solutions to government partners that serve the public good through high-quality corrections and detention management, innovative and cost-saving real estate solutions, and a growing network of residential reentry centers to help address America's recidivism crisis. We are a publicly-traded real estate investment trust (REIT), and the nation's largest owner of partnership correctional, detention and residential reentry facilities.</strong></p> <p><strong>CoreCivic has been a flexible and dependable partner for government for more than 30 years. Our employees are driven by a deep sense of service, high standards of professionalism and a responsibility to better the public good.<br /><br /><br /><br /></strong><strong><a href="https://jobs.corecivic.com/" target="_blank" rel="noopener noreferrer">View More Jobs</a><br /></strong></p> https://www.corecivic.com/

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Full Time

Overview: ABOUT US: <br /><br />CoreCivic is a diversified government solutions company with the scale and experience needed to solve tough government challenges in cost-effective ways. We provide a broad range of solutions to government partners that serve the public good through high-quality corrections and detention management, innovative and cost-saving government real estate solutions, and a growing network of residential reentry centers to help address America&rsquo;s recidivism crisis. We are a publicly traded real estate investment trust (REIT) and the nation&rsquo;s largest owner of partnership correctional, detention and residential reentry facilities. We have been a flexible and dependable partner for government for more than 30 years. <br /><br />Professionalism. Respect. Integrity. Duty. Excellence (PRIDE). These words describe the essence of our values as a company. PRIDE is personified everyday by every employee at every level at CoreCivic. It shapes the choices we make and is the roadmap to how we achieve our mission and realize our vision. CoreCivic is the leader in private correctional facilities and we are growing into the leader in the rehabilitation and re-entry market with facilities nationwide. Our facilities make a difference with the giving of both time and resources to organizations that are doing important work locally. CoreCivic is always recognized as a valued partner because of our unwavering commitment to community. Learn more at http://www.corecivic.com/. MINIMUM
Responsibilities: The Claims Manager is responsible for the configuration, implementation and administration of the claims processing and auditing program. Manages the inmate medical claims review staff to ensure quality and process improvements in claims administration. Interfaces with medical providers to conduct and manage random sample reviews to determine medical claims processing accuracy and timeliness. Communicates with providers to coordinate operational reviews to assess administrative processes and controls. Recommends, formulates and administers departmental policies and procedures. ESSENTIAL FUNCTIONS: The incumbent should be able to perform all of the following functions at a pace and level of performance consistent with the job performance requirements. <ul> <li>Monitors daily claim volume and assigns work to ensure claims are processed in order received. Directs and motivates claims processors to ensure inventory, interest, claims timeliness and other metrics are maintained within established guidelines.</li> <li>Determines work procedures, prepares work schedules, and expedites workflow. Establishes and maintains workflows and procedures to comply with state, federal and internal processing standards.</li> <li>Supervises staff in the performance of their duties and evaluates as prescribed by company policy. This includes, but is not limited to: on-boarding new employees, evaluating performance and preparing written performance appraisals, listening to concerns and effectively resolving disputes or issues, taking corrective or disciplinary action, developing work schedules for staff and approving leave requests.</li> <li>Interacts with other departments to coordinate exchange of information about benefits, provider contracts, payments and changes that affect claims processing.</li> <li>Monitors departmental and individual performance. Trains and re-educates claims staff on correcting errors. Monitors effectiveness of related training classes and curriculum. Makes recommendations to address process and quality gaps.</li> <li>Conducts pre-payment and post-payment audits to verify accurate claims payment and/or denials.</li> <li>Conducts root cause analyses on systemic issues. Formulates action plans to avoid incorrect payment through review of contracts, Medicare claims payment rules, internal systems and patient impact.</li> <li>Researches and responds to claim escalations from provider relations and health services operations. Facilitates the research and resolution of claim issues arising from appeals and grievances.</li> <li>Collaborates with third party administrator on electronic claims processing to ensure quality and process improvements in claims administration.</li> <li>Domestic U.S. travel may be required.</li> </ul>
Requirements: <ul><li>Graduate from an accredited college or university with a Bachelor’s degree in Business Administration, Healthcare Administration, or a related field. </li><li>Three years of experience in complex claims processing and/or auditing within the health insurance industry or medical healthcare delivery system. </li><li>Additional claims experience may be substituted for the required education on a year-for-year basis. </li><li>Must be extremely organized, attentive to detail, and able to multi-task while maintaining a professional demeanor. </li><li>Supervisory experience required. </li><li>Proficiency in Microsoft Office applications required. </li><li>A valid driver’s license is required.</li></ul> PREFFERRED QUALIFICATIONS: <ul>Certification with AAPC or AHIMA is preferred. Knowledge of CMS requirements preferred. </li>Experience with coding systems such as HCPCS, CPT and/or ICD preferred. </li></ul>