Claims Technical Manager
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. CLAIMS TECHNICAL MANAGERPosition DescriptionThis position is responsible to oversee all aspects of day to day technical claims applications including, auditing, authorization/referrals, coding, coordination of benefits including MSP (Medicare Secondary Payor Rules), recoveries, testing, training, and subrogation. Ensure that resources are maximized and efficiencies gained through the identification of process gaps. Complete monthly reporting duties and participate in internal/external meetings and work groups.Represent UCare on various external health care administrative groups and committees, such as AUC and TAGS. ·Monitor health care regulatory resources, including, but not limited to, the Centers for Medicare and Medicaid Services (CMS) and the Minnesota Department of Human Services (DHS) to ensure UCare's claims operations are compliant with associated State and Federal regulations.·Monitor and work with UCare's team to ensure all federal and state fee schedules and reimbursement methodologies are current within the claims processing system.·Represent UCare by actively participating in various administrative groups and committees (e.g., Administrative Uniformity Committee).·Maximize UCare's subrogation and coordination of benefits (COB) savings by actively pursuing primary payer information and third party liability prior to claims payment while ensuring that subrogation and COB rules and regulations are adhered to. ·Improve and preserve relationships with providers by; conducting professional and helpful communications regarding reimbursement questions, ensuring accurate and timely adjustments, managing retroactive claim processing activities due to system or process changes, and identifying and implementing opportunities for quality improvement and increased efficiencies.·Provide claims analysis with trending to identify over-payment recoveries, claims training needs and work with Provider education in an effort to increase overall claims accuracy. ·Manage projects that require the implementation of cross departmental operational changes while ensuring that organizational interdependencies are accounted for prior to the implementation. Monitor implementation on an ongoing basis, including batch adjustment and batch radj.·Identify and implement process improvement opportunities in an effort to increase efficiency and reduce rework.·Collaborate with Claims Processing Manager to develop, implement, present, and assess Claims Department training needs, work instructions development, and operational enhancements.·Recruit, train, coach, and evaluate supervisory staff. Establish, communicate, and enforce performance standards and monitor progress.·Other duties and projects as assigned.EducationAssociates degree or Bachelor's degree preferred with course work in medical terminology, CPT and ICD-9 coding; demonstrated experience may be considered in lieu of a degree.Required Experience
Five years supervisory/managerial experience of claims operations, provider reimbursement structures and medical benefits. High level of claims experience in Medicare, Medicaid, HMO and/or indemnity claims processing, CPT and ICD-9 coding, Coordination of benefits/rules established by the NAIC, including MSP (Medicare Secondary Payor Rules), medical terminology and anatomy. Employee performance coaching, discipline, and evaluations processes.Preferred ExperienceWorking knowledge of Medicaid, General Assistance, Medical Assistance, Minnesota Care and Medicare helpful. Previous Amisys Claims System, MACESS Exp, training and recovery experience a plus. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.