Director of Advocacy, Legislative Affairs & Community Engagement

The Director of Claims Management (DCM) contributes by working in concert with the Chief of Care Management and Division Executive Management to set the strategic direction of the Claims Department and executes the tactics to achieve federal and state regulatory, grant, operational and accreditation compliance and service goals. The DCM further contributes to organizational success by assuring the claims management system and operational processes are compliant with various grant contracts, CA state MediCal and Department of Managed Care and federal CMS/Medicare regulatory and contractual requirements. The claims systems (e.g., RAM Technologies Health Suite) must be updated timely, configured accurately, and processes well researched and documented to ensure accuracy of payment, maximize auto adjudication, and enhance staff knowledge and productivity. The DCM enhances the reputation of the organization by developing and maintaining a best-in-class claims department that produces timely and accurate claim management results that meet customer, patient, regulatory contractual, accreditation, compliance, litigation, and quality of service standards for accuracy, timeliness, and financial management practices. You will be a passionate advocate for our top initiatives. To be successful as the DCM, it is crucial to ensure that the Core Values and Mission stay top of mind with all that you do. The DCM will work as part of a close-knit team to deliver a positive experience and outcome to medical providers, patients, various state Grantee Offices, allied health vendors, and staff. The DCM leads as the subject-matter expert on claims payment and process flow and accurate encounter data, as well as leading the department in internal audits, partnering with Compliance and Finance to ensure smooth and organized external local, state, and federal audits, and addressing any findings in audits with a well-planned and executed corrective action and follow-up. The DCM develops, monitors, documents, and reports key measurements, trends, and operational issues to leadership in a timely manner. TO APPLY: Please forward your resume to Amanda Sonus at asonus@pailingroup.com

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