Manager of Operations - Transplant
Loyola

Maywood, Illinois

Posted in Medical and Nursing


This job has expired.

Job Info


Employment Type:
Full timeShift:
Day Shift

Description:

The Manager of Operations -Transplant is responsible for the oversight of claims processing, eligibility/benefits, and customer service in a health insurance environment. The Manager of Operations - Transplant will review and implement efficient and effective processes with regards to claims processing, including increasing or maintaining auto adjudication rates. In addition, this person manages the administration of the organization's database to ensure that all elements of claims processing are loaded accurately.

Position Requirements:

  • Reviews and implements efficient and effective processes with regards to claims processing, including increasing or maintaining auto adjudication rates, operational activities such as encounter data submission, check run oversight, accurate provider loading, and development and maintenance of claims queries and reporting.
  • Ensures claims are processed within regulated timeframes and according to all Medicare regulations and HMO contracts / DOFR. This position will coordinate plan audits, produce and review examiner productivity reports and create and conduct corrective actions as required.
  • Maintains and oversees the claims system software and other related software to confirm proper functionality and ensuring it meets the needs of the department.
  • Acts as the lead for system related projects (e.g., system review and rebuild, new business implementation, etc.). Responsible for the oversight and/or hands on of the set-up and intake of EDI for inbound claims and the development of outbound EDI.

Minimum Education:

Required: Bachelor's Degree; Master's degree preferred

Residency: N/A

Minimum Experience:

3-5 years of managerial experience required

Minimum of 4 years managed care experience and 2 years' experience in hospital, health plan or physician setting. Preferred experience in a delegated claims processing shop environment.

Our Commitment to Diversity and Inclusion:

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

#Serving Together in the Spirit of the Gospel #Community #Positive Health Outcomes

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.


This job has expired.

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