Here is a small list of our benefit programs:Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays100% paid parental leave up to 6 weeksImmediate eligibility for retirement plans with employer contribution up to 9.5%Generous medical, dental, vision plans in addition to employer paid disability and life insurance.Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
About Denver Health
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based heal
Health insurance
Dental insurance
Vision insurance
Paid time off
Parental leave
Additional Information
We are recruiting for a mission-driven Manager, Claims - Denver Health Medical Plan (Must Live in Colorado) to join our team!
We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey.
Our Values
Respect | Belonging | Accountability | Transparency
Department
Managed Care Administration
* Must Live in Colorado
* Hybrid role with an in-office requirement of 3 days per week in Denver, Colorado
Job Summary
Maintains supervision of the day to day claims processing function for the Denver Health Medical Plan. Trains claims business analysts to ensure accurate processing of claims. Educates regarding subrogation and coordination of benefits. Reviews claims adjudication for timeliness and accuracy of payment. Educates claims business analysts regarding contract terms. Interfaces with other personnel within the Managed Care Division to assist with extraction of accurate claim information for reporting purposes. Interfaces with Managed Care Information Systems regarding system changes and data extraction.
Essential Functions :
Oversees the day-to-day operations within the DHMP Claims Department and the vendor Claims Department. (20%)
Ensures optimal performance in claims quality, claims financial accuracy, and compliance with State and Federal Regulations. (10%)
Manages claims analyst to resolve claims issues related to authorization issues, provider issues, claim edits, and claim audits. (10%)
Manages proactive and retrospective claims review that are done on a continual basis to ensure accuracy and to identify system and/or processing issues. (10%)
Manages claim recoupment efforts. (10%)
Assists with system upgrade efforts. (10%)
Recommends, reviews and modifies all necessary policies and procedures within the department. (10%)
Prioritize work volumes on a daily basis. (10%)
Drives change initiatives to address future-oriented business needs. (10%)
Education :
Bachelor's degree required
Work Experience :
Five years of health care claims experience required and
Two years of lead or supervisory experience required
Licenses :
Knowledge, Skills and Abilities :
Fluent understanding of HCPC codes, UB 04 forms, HCFA 1500 forms, RBRVS fee schedules, and other common claim coding conventions.
Understanding of NAIC coordination of benefit rules.
Excellent verbal and written communication skills.
Demonstration of good supervisory skills.
Knowledge of general report writing.
Ability to work independently and collaboratively, generate creative ideas for interventions with other internal and external team members to ensure timelines are met
Proficient in Microsoft Suite
* Must Live in Colorado
* Hybrid role with an in-office requirement of 3 days per week in Denver, Colorado
Shift
Days (United States of America)
Work Type
Regular
Salary
$88,100.00 - $136,600.00 / yr
Denverhealth · Denver