UCare

CCO Associate Director - Claims Services

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Oct 01, 2020
Closes
Oct 23, 2020
Ref
2112
Category
Healthcare
Employment Status
Full Time
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.

Rewards

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.

www.ucare.org/careers/

EOE/AA

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than 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. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 11 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

CCO ASSOCIATE DIRECTOR - CLAIMS SERVICES

Position Description

This position is responsible to oversee claims processing, recoveries, transactional coding, subrogation, member reimbursements, provider appeals and all CCO support functions. Responsible for ensuring that all claims processing performance is timely, accurate and efficient and meets all regulatory requirements for both state and federal programs. Measure and report team and individual production results. Ensure teams meet internal and external service level agreements (SLAs) and make all efforts to deliver an exceptional member and provider experience. This position will work with both departmental and organizational business partners to resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase Claims service levels.

• Analyze and trend claims related data to identify inefficiencies and implement process improvement; provide guidance and support to all claims and operations personnel towards resolution of claim-related problems with an emphasis on root cause analysis and resolution of problems.

• Oversee claims services processes, leaders and staff to ensure accurate claims payment to providers. Maintain departmental performance standards; review and analyze weekly and monthly department performance reports; address performance issues and implement needed interventions and coaching individual employee performance to meet and exceed production and quality metrics.

• Accountable for the development, implementation and maintenance of workflows, policies and procedure for Claims Services and understand how they relate to other department processes and procedures; confirm that all desk level procedures have been finalized and adhere to contractual and regulatory requirements and ensure efficient claims services operations.

• Assist in the development and execution of department plans and actions that are integrated with other departments and support the corporate strategic plan and UCare prioritized projects and initiatives.

• Collaborate with Provider Relations & Contracting, Provider Services, Clinical Services, Pharmacy and Mental Health Substance Abuse Disorder teams to develop strategies to improve claims payment accuracy, processing timelines and provider and member experience.

• Partner with the Core Transformation Program to support the implementation of the remaining product portfolio on HealthRules.

• Participate as a member of the CCO Leadership Team. Ensure transparency and communication regarding claims services metrics, performance, risks and issues across the team.

• Select, train, develop and evaluate staff and leaders to ensure desired performance. Establish and communicate clear performance standards.

• Serve on various UCare committees and workgroups.

• Other projects and duties, as assigned.

Education

Bachelor's degree in health care field, business administration or related field. Master's degree preferred. Ten or more years of demonstrated experience may be considered in lieu of a degree.

Required Experience

Five years managerial/supervisory experience in a managed care organization or other health insurance environment. Seven years of experience with claims processing, coding and/or claims support functions. Familiar with Medicaid, Medicare, Dual and/or Commercial claim regulations.

Preferred Experience

Business analysis experience. Process improvement experience.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, 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.

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