State & Federal Government Jobs in the USA
Website Signature Healthcare
Job Description:
Signature HealthCARE is a family-based healthcare company that offers integrated services in 10 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, home health, cognitive care, and telemedicine. Signature Advantage, a subsidiary of Signature Healthcare, is an Institutional Special Needs Plans (I-SNP) which is a Medicare Advantage Plan. As an I-SNP, we provide a Medicare Advantage plan for people who are eligible for Medicare and who reside in our partner nursing facilities. Our Sacred Seven Values of Heroic, Compassion, Teamwork, Respect, Integrity, Patience and Positivity make this an incredible place to serve and make a difference in the lives of our patients, residents.
Job Responsibilities:
- Participate in workgroups to help resolve complex payment issues involving claims configuration, health services, network and contracting
- Completes audits on accuracy of claims system set-up and manage payment cycle to ensure compliance to contract requirements.
- Perform root cause analysis of claims payment discrepancies
- Conduct post payment coding reviews
- Identify risks and ensure processing of all claims per CMS guidelines How you will spend your time:
- Other special projects and duties, as assigned.
- Analyze claims to ensure optimal quality and coordinate with CFO for check run approvals
- Review and analyze provider disputes
- Analyze complaint, appeal, dispute, and grievance data, as it relates to claims, develop trend reports and work with various committees to identify opportunities for improvement and increase member and provider satisfaction.
- Ensures plan meets standards for Claims Adjudication.
- The Claims Manager is responsible for accuracy and coordination of Claims Set up with TPA offices
Job Requirements:
- Ability to interpret coding guidelines, CMS regulations, reimbursement, Medicare Claim Processing for accurate application of policy to claim edits and audits.
- Strong attention to detail and accuracy, excellent organization skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
- Customer service oriented with the ability to work well under pressure.
- Ability to work with minimal supervision, take initiative and make independent decisions.
- You’ll be around other co-workers, and their guests.
- Strong analytical and problem-solving skills.
- Ability to communicate at all levels of organization and work well within a team environment in support of company objectives.
- Approachable flexible and adaptable to change.
- You’ll work mostly indoors on floors that are tiled or carpeted.
- Ability to take initiative and make suggestions for improvements.
- Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors. Your work environment:
- Ability to deal with new tasks without the benefit of written procedures.
Job Details:
Company: Signature Healthcare
Vacancy Type: Full Time
Job Functions: Paramedic
Job Location: Louisville, KY, US
Application Deadline: N/A
jobbry.net