Medical Insurance Department Manager
9 hours ago
**Job Summary**
The goal of the Medical Insurance Manager role is to supervise staff responsible for approvals, billing claims and reconciliation, routing upstream issues, and resolving denials to ensure accurate and timely collections, especially for the Managed Medicaid payers. To be successful in this role, Managers are required to have in-depth knowledge in medical field and medical coding guidelines.
- Overall, in charge of insurance related matters.
- Insurance Manager will mainly supervise a group of Insurance Officer. He or she will monitor staff activity and coaches improvements to staff knowledge and process adherence.
- He or she needs to make sure that staff meets or exceeds established standards for metrics specific to assigned Accounts Receivable inventory.
- Insurance Manager must maintain the highest standards of compliance within all work.
- He or she will be the internal and external point of contact in all insurance related matters. Will communicate internally between teams and externally with insurance companies with a high-level of clarity and specificity for efficient communication.
- Follows up and negotiates with Insurance Companies where needed to ensure approval of problematic cases.
- Negotiates terms of agreements with the insurance companies when needed.
- Finalize disallowance write-offs in coordination with Accounts Receivables department after proper reconciliation.
- He or she will be responsible in training the staff and other related departments. Will train for process changes and overall professional development.
- Submits Insurance department statistics monthly.
- Attends seminar and meetings with insurance companies.
- Cascade all new information to Doctors and Management.
- Will be the head of root-cause denial analysis. He or she will fix all issues and collect insurance Accounts Receivable.
- Check all the work of the Insurance Officer before proceeding with the submission.
- Conducts training to the concerned departments for refresher or insurance updates.
- Establishes, communicates, and manages goals, targets and expectations for the department and individual performance.
- Maintains low claim ratio percentage.
- Other duties assigned from time to time.
**Job Types**: Full-time, Permanent
**Education**:
- Bachelor's (required)
**Experience**:
- Medical Insurance: 5 years (preferred)
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