Job Description
Health Maintenance Inc. is a premier healthcare provider dedicated to delivering exceptional medical services to our patients. We are currently seeking a dynamic and experienced Medical Claims Manager to join our team in Makati City. In this critical role, you will oversee the entire claims processing lifecycle, ensuring efficiency, accuracy, and compliance with regulatory standards.
As a Medical Claims Manager, you will lead a team of claims specialists, develop strategies to reduce claim denials, and collaborate with medical and billing departments to optimize reimbursement. Your expertise will contribute to streamlining operations and enhancing patient satisfaction by ensuring timely and fair processing of claims.
If you have strong leadership skills, in-depth knowledge of medical coding and billing, and a passion for improving healthcare administration, we invite you to apply. This is an exciting opportunity to make a significant impact within a growing organization that values excellence and innovation in healthcare management.
Responsibilities
- Oversee the end-to-end processing of medical claims, ensuring timely and accurate submission and reimbursement.
- Manage and mentor a team of claims processors, providing guidance, training, and performance evaluations.
- Develop and implement claims management policies and procedures to improve operational efficiency and reduce errors.
- Monitor claims metrics, analyze trends, and prepare reports for senior management on claim volumes, denial rates, and turnaround times.
- Collaborate with medical coders, billers, and healthcare providers to resolve claim discrepancies and ensure compliance with payer requirements.
- Stay updated on changes in healthcare regulations, coding guidelines (ICD-10, CPT), and payer policies to ensure adherence.
- Act as the primary point of contact for complex claims issues, appeals, and audits from insurance companies.
Qualifications
- Bachelor's degree in Healthcare Administration, Nursing, Business, or a related field.
- Minimum of 5 years of experience in medical claims processing, with at least 2 years in a supervisory or managerial role.
- In-depth knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and billing processes.
- Strong understanding of insurance payer policies, compliance requirements (HIPAA, local regulations), and claims adjudication.
- Excellent analytical and problem-solving skills with the ability to interpret data and drive improvements.
- Proven leadership and team management abilities with experience in training and performance management.
- Proficiency in claims management software and Microsoft Office Suite.
- Excellent communication and interpersonal skills, with the ability to collaborate across departments.