Position Number:122-3124 Open Date:10/12/2009 Close Date:Open until filled Program:Health Coverage Department:Claims Location:West Palm Beach, FL
Dedicated to the Health of our Community The Health Care District of Palm Beach County is a special taxing district that is an equal opportunity employer of approximately 1000 employees. Established in 1988, the Health Care District's mission is to maximize the health and well-being of Palm BeachCounty residents by addressing health care needs and planning for the access and delivery of health services.
Working in a fast-paced environment, this individual will perform all managerial work in conducting daily operations of the Claims Department. Employees in this position develop work standards and ensures departmental objectives are met, including developing training programs to address deficiencies as needed. Ability to effectively manage a responsive and cohesive team a MUST!
Preparation of the weekly Quality and Production Reports to the Director of Reimbursement; Monitors staff productivity levels and work quality.
Monitors weekly mail receipts and adjusts the subsequent workflows to accommodate fluctuations; Also monitors claims processing turnaround times and claim hold reports to ensure prompt payment requirements are met. Assists with eliminating backlog as needed.
Manages department personnel functions, including hiring, evaluations, training, time records, etc.
Reviews provider appeals and customer service inquiries for the purpose of determining reversal or upholding of denial.
Assists Customer Service and Provider Services Departments in the absence of the Director of Reimbursement.
Responds to both written and telephone, inquires from the public, other personnel, and outside agencies; resolves the concern or directs to the appropriate entities.
Meets with the Director of Reimbursement to discuss claims related issues; Attends appropriate management meetings in the absence of the Director of Reimbursement.
Maintains knowledge of Medicaid prepaid health contract and other applicable contractual requirements for all lines of business. Confers with other department heads and providers for the purpose of discussing and resolving claims issues.
Associate’s Degree in Business Administration or related field required; Bachelor’s degree in the same preferred.
Minimum of three (3) to 5 (five) years management level work experience that includes directly managing all the day-to-day responsibilities of supervising a large team (20+ employees) and the analysis, adjudication and adjustment of health claims utilizing an automated claims system required; Knowledge of Medicaid and Medicaid prepaid contract and Medicaid Provider Reimbursement Handbooks required.
The Health Care District is an Equal Employment Opportunity Employer and maintains a Drug Free Workplace. Qualified individuals with disabilities who require an accommodation to participate in the application process should contact Human Resources. Veterans preferred.
For more information about the Health Care District and other employment opportunities, including Claims Examiner, visit www.hcdpbc.org
