Job Description

New Century Health is leading transformative change in specialty care management. By combining medical management expertise with a deep understanding of healthcare informatics, physician management and healthcare technology systems development, we generate insights that drive leading edge and effective innovation. What does this mean to you? It means that when you join us, you will be a key contributor to one the fastest growing healthcare services in the National Oncology and Cardiology care management space today. With your knowledge, skills and abilities, you will impact the delivery of care and directly contribute to our ability to positively impact and meet the critical unmet needs of patients suffering from all types of cancer.
  
We support our employees with an outstanding benefit package that features programs like employee paid medical benefits, 100% match on your 401k contribution up to 4% of your base salary, generous tuition reimbursement, as well as above average paid time off. If you are interested in working with some of the most dedicated, passionate and smartest people on the planet, express your interest in speaking with us and we will respond immediately.


SCOPE & RESPONSIBILITIES OF ROLE:

This position plays a vital role in the team’s mission to create and sustain added value to NCH, its Network Partners, Providers, Members and Fellow Colleagues by consistently demonstrating professionalism and excellent customer service. Responsibilities of the role include overseeing and assisting with the day-to-day operations of the Claims team; Ensures all compliance standards and requirements are met; Monitors the performance of the Claims team to ensure department goals are met; Acts as a subject matter expert on specialty areas to effectively address questions and resolve complex claims issues; Identifies potential enhancements and changes to workflow; Collaborates with the Sr. Director to develop training programs for staff; and provides input for performance reviews.


KNOWLEDGE, SKILLS & ABILITIES:
  • Ability to select, train, develop, motivate and retain high performing team members
  • Ability to effectively manage conflict and maintain calm demeanor in stressful situations 
  • Strong organizational skills
  • Strong attention to detail with a high level of accuracy
  • Ability to communicate effectively and collaborate with internal and external stakeholders
  • Advanced knowledge of CPT and ICD-10 codes, medical terminology, and CMS regulations
  • Achieves defined productivity, timeliness, and quality standards
  • Consistently demonstrates ability to problem solve issues to resolution
  • Monitor reports on production and quality of staff; conducts quarterly audits on closed claims
  • Maintain thorough understanding of client specific and industry standards
  • Communicates department and individual performance goals to team and evaluates performance 
  • Assigns claims to the appropriate staff based on staffing levels, volume, type & adjudicator experience 


EXPERIENCE, EDUCATION, LICENSES & CERTIFICATIONS:
  • Minimum 5 years of claims processing experience in a Managed Care environment (required)
  • Minimum 2 years of experience in a leadership/supervisory role (required)
  • Bachelor’s Degree (preferred)
  • Proficient in Microsoft Office - Word, Excel, and Access


ESSENTIAL JOB FUNCTIONS:
  • Specific vision abilities, including close vision, operate computer screen for extending periods of time
  • May be required to sit or stand for extended periods of time
  • May be required to occasionally lift or move up to 25 pounds
  • Ability to read, write and speak the English language fluently with patients and providers

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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