Morgan Consulting Resources, Inc. - Healthcare Executive Search
Director of Claims
Morgan Consulting Resources, Inc. - Healthcare Executive Search, Rancho Cucamonga, California, United States, 91739
Director of Claims at Morgan Consulting Resources, Inc. - Healthcare Executive Search
Join to apply for the
Director of Claims
role at
Morgan Consulting Resources, Inc. - Healthcare Executive Search .
The role is based in Rancho Cucamonga, CA. A hybrid schedule is available allowing three days in the office and two days working remotely.
About the Organization With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. In its 29th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing network of over 8,000 providers and nearly 4,000 Team Members (Employees). Through dynamic partnerships, award-winning service, and a tradition of quality care, IEHP is fully committed to its Mission, Vision, and Values.
IEHP has consistently achieved outstanding employee engagement scores from their 4,000+ Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row! For details regarding IEHP, please visit: iehp.org.
About the Position Reporting to the Senior Director, Claims, the Director, Claims is responsible for the direction and oversight of all medical claims processing, provider disputes & appeals, quality assurance, and training activities. Additional responsibilities include ensuring regulatory compliance, strategic planning, and staff development.
Base Pay Range $154,128.00/yr – $254,300.80/yr
Responsibilities
Ensure all claims, appeals and disputes are accurately handled within Federal and State regulatory requirements
Oversight of quality assurance audits and initiatives focused on payment accuracy and streamlined processes
Oversight of all department training activities
Primary department representation for internal/external claim audits and regulatory appeals and inquiries
Responsible for ensuring regulatory reporting and fulfilling corrective action plans for identified deficiencies
Coordinates department purchasing needs and originates RFPs and RFQs for needed services
Prepares department budget and staffing plan
Ensures all department policies and provider manual claim policies are maintained
Interacts with other IEHP departments to collaborate on key initiatives, issue resolution and Lean activities
Experience Requirements
Five (5) years of healthcare administration experience required
Four (4) or more years in a leadership capacity required
Two (2) years of experience with an HMO or managed care experience required
Medi-Cal/Medicaid claims experience required and Medicare/DSNP/ACA Exchange experience preferred
Educational Requirements
Bachelor's degree in business administration, accounting, or healthcare from an accredited institution required
Master’s degree from an accredited institution preferred
Knowledge & Skills
Solid understandings of rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures.
Principles and techniques of supervision and training.
To express interest, apply online and contact:
Erica Eikelboom, Principal & Executive Search Consultant
Seniority Level Director
Employment Type Full-time
Job Function Management
Industries Hospitals, Health Care, Insurance
#J-18808-Ljbffr
Director of Claims
role at
Morgan Consulting Resources, Inc. - Healthcare Executive Search .
The role is based in Rancho Cucamonga, CA. A hybrid schedule is available allowing three days in the office and two days working remotely.
About the Organization With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. In its 29th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing network of over 8,000 providers and nearly 4,000 Team Members (Employees). Through dynamic partnerships, award-winning service, and a tradition of quality care, IEHP is fully committed to its Mission, Vision, and Values.
IEHP has consistently achieved outstanding employee engagement scores from their 4,000+ Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row! For details regarding IEHP, please visit: iehp.org.
About the Position Reporting to the Senior Director, Claims, the Director, Claims is responsible for the direction and oversight of all medical claims processing, provider disputes & appeals, quality assurance, and training activities. Additional responsibilities include ensuring regulatory compliance, strategic planning, and staff development.
Base Pay Range $154,128.00/yr – $254,300.80/yr
Responsibilities
Ensure all claims, appeals and disputes are accurately handled within Federal and State regulatory requirements
Oversight of quality assurance audits and initiatives focused on payment accuracy and streamlined processes
Oversight of all department training activities
Primary department representation for internal/external claim audits and regulatory appeals and inquiries
Responsible for ensuring regulatory reporting and fulfilling corrective action plans for identified deficiencies
Coordinates department purchasing needs and originates RFPs and RFQs for needed services
Prepares department budget and staffing plan
Ensures all department policies and provider manual claim policies are maintained
Interacts with other IEHP departments to collaborate on key initiatives, issue resolution and Lean activities
Experience Requirements
Five (5) years of healthcare administration experience required
Four (4) or more years in a leadership capacity required
Two (2) years of experience with an HMO or managed care experience required
Medi-Cal/Medicaid claims experience required and Medicare/DSNP/ACA Exchange experience preferred
Educational Requirements
Bachelor's degree in business administration, accounting, or healthcare from an accredited institution required
Master’s degree from an accredited institution preferred
Knowledge & Skills
Solid understandings of rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures.
Principles and techniques of supervision and training.
To express interest, apply online and contact:
Erica Eikelboom, Principal & Executive Search Consultant
Seniority Level Director
Employment Type Full-time
Job Function Management
Industries Hospitals, Health Care, Insurance
#J-18808-Ljbffr