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UCLA Health
Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)UCLA Health • Los Angeles, CA, United States
Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

UCLA Health • Los Angeles, CA, United States
3 days ago
Salary
$98,200.00–$214,600.00 yearly
Job type
  • Full-time
Job description

Claims Manager Of The Medicare Advantage Plan

Work Location: Los Angeles, CA, USA

Onsite or remote flexible hybrid work schedule Monday - Friday, 8:00am-5:00pm PST

Salary Range: $98200 - 214600 Annually

Employment Type 2 - Staff: Career Duration Indefinite

Primary Duties And Responsibilities

Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence. The Claims Manager of the Medicare Advantage Plan will:

  • Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments.
  • Foster a positive, high-performing team culture focused on quality and exceptional customer service
  • Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures
  • Empower the team to navigate challenging scenarios with confidence and consistency

Salary Range: $95,400 - $208,300/annually

Note: This position is flexible-hybrid.

Job Qualifications

We're seeking a self-motivated, service-driven leader with:

Required:

  • Bachelor's degree in business, health care or a related field and/or equivalent work experience
  • Five or more years of claims operations experience in a Medicare Advantage or related environment
  • Three or more years of managing personnel in a claims processing environment
  • In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
  • Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.
  • Knowledge of standard electronic and paper claim formats
  • Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines
  • Computer proficiency with Microsoft Office Suite and data visualization tools
  • Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements
  • Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)
  • Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)
  • Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT
  • Excellent problem identification, resolution, and analytical abilities
  • Strong communication, interpersonal, and analytical skills
  • Ability to develop, implement, and evaluate methods/systems to improve efficiency
  • Ability to lead and facilitate cross-functional workgroups
  • Proficiency in achieving compliance with regulatory requirements
  • Ability to travel/attend off-site meetings and conferences

Preferred:

  • Certified Professional Biller (CPB)
  • Certified Revenue Cycle Representative (CRCR)
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Claims Manager, Medicare Advantage Plan (Flexible-Hybrid) • Los Angeles, CA, United States

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