Manager – Health Services

This is a fully remote position, open to applicants in Virginia, +1 more state.

📋 Description

• Oversee the identification of potential enhancements for claim editing and clinical programs to ensure adherence to Medicare NCDs and LCDs, as well as Federal and State legislation.

• Collaborate and work alongside functional leaders and various business units to guarantee quality and comprehensive payment accuracy within the Medicare NCD/LCD and Federal/State legislative framework.

• Offer support and management of savings opportunities and the implementation of provider/customer deviations.

⛳️ Requirements

• Certified Professional Coder (CPC) certification.

• A minimum of 3 years of experience in processing and/or researching claims for proper claim editing.

• At least 3 years of experience in consistently achieving project deliverables.

• Over 5 years of experience in Managed Care/Healthcare settings.

• Familiarity with Compliance Program Guidelines, including CMS Medicare NCD/LCD and Federal and State legislation.

• Experience in Medicare Rules and Regulations related to Healthcare Compliance.

• Proficient in ClaimsXten.

• High school diploma required; Bachelor's degree preferred.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Comprehensive benefits package designed to promote physical, emotional, and financial well-being.