Claims Director

📋 Description

• Lead, direct, and manage the department effectively.

• Tasked with gathering, researching, and analyzing diverse data to support Executive Management in making decisions related to provider services.

• Ensure the identification of Medicaid and state-funded covered services, including retroactive Medicaid coverage, to guarantee appropriate enrollment and claims payment.

• Facilitate communication between providers and department staff to resolve any enrollment, payment, and billing concerns.

• Maintain a comprehensive understanding of the entire claims management/accounts receivable system.

• Keep abreast of Medicaid and state-funded billing regulations.

⛳️ Requirements

• Bachelor’s degree in a business-related field.

• At least three (3) years of experience in extensive claims filing, data reporting, and financial analysis.

• Familiarity with Professional (Form CMS1500) and Institutional (UB04) billing forms, as well as ICD-10/CPT/HCPCS coding, CAQH, HIPAA, and claims processing.

• A valid driver’s license is required.

• Must be a resident of North Carolina.

• Ability to travel within the catchment area as needed.

• A Master’s degree in a related business field is preferred.

• Previous experience supervising two (2) or more employees is preferred.

🏝️ Benefits

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO) plus 12 paid holidays during your first year.

• NC Local Government Retirement Pension (defined-benefit plan).

• 401k with a 5% employer match and immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend for remote work supplies.