Presbyterian Healthcare Services
Director - Claims
Presbyterian Healthcare Services, Albuquerque, New Mexico, United States, 87101
Overview
The Director of Claims and Encounters provides strategic leadership, fiscal accountability and operational excellence for the Presbyterian Health Plan (PHP) Claims Operations and Encounter Resolution teams. This leader directs the operations of the Claims Department for Commercial/ASO, Medicare and Medicaid products, ensuring all functions related to claims receipt, processing and payment are performed within established quality and quantity standards. You will lead the encounters resolution team and be the leader responsible for encounters completeness and facilitating maximized Medicaid rate setting. This leadership role is accountable to drive execution of operational strategy across responsible areas through accurate, timely and efficient delivery of production activities that incorporate market-leading practices. In addition to operational leadership, this role champions and executes prioritized deployment of Auto-Adjudication methodologies, use of Robotic Process Automation (RPA/Bots), increased first-pass acceptance and overall encounter processing simplification to achieve operational optimization and cost effectiveness. The role will lead department strategic objectives and aim to achieve measurable gains in reduced cycle times and improved functional effectiveness in departmental processes. It will leverage deep claims and encounters expertise to improve the member and provider experience. This position is intended to be conducted in the state of New Mexico. Interested in learning more? Text 505.388.0350 or schedule directly with me by clicking here!
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The Director of Claims and Encounters provides strategic leadership, fiscal accountability and operational excellence for the Presbyterian Health Plan (PHP) Claims Operations and Encounter Resolution teams. This leader directs the operations of the Claims Department for Commercial/ASO, Medicare and Medicaid products, ensuring all functions related to claims receipt, processing and payment are performed within established quality and quantity standards. You will lead the encounters resolution team and be the leader responsible for encounters completeness and facilitating maximized Medicaid rate setting. This leadership role is accountable to drive execution of operational strategy across responsible areas through accurate, timely and efficient delivery of production activities that incorporate market-leading practices. In addition to operational leadership, this role champions and executes prioritized deployment of Auto-Adjudication methodologies, use of Robotic Process Automation (RPA/Bots), increased first-pass acceptance and overall encounter processing simplification to achieve operational optimization and cost effectiveness. The role will lead department strategic objectives and aim to achieve measurable gains in reduced cycle times and improved functional effectiveness in departmental processes. It will leverage deep claims and encounters expertise to improve the member and provider experience. This position is intended to be conducted in the state of New Mexico. Interested in learning more? Text 505.388.0350 or schedule directly with me by clicking here!
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