Contra Costa Health
Claims Manager - Contra Costa Health Plan
Contra Costa Health, Martinez, California, United States, 94553
Company Description
Contra Costa Health is offering an excellent opportunity for two (2) Managers within Contra Costa Health Plan (CCHP)'s Claims Department. CCHP is a federally qualified, state‑licensed, and county‑sponsored Health Maintenance Organization (HMO) serving Contra Costa County in the East Bay of the San Francisco Bay Area. Established in 1973, CCHP was the first county‑sponsored HMO in the United States and today serves as the largest managed care health plan in Contra Costa County, covering more than 250,000 residents. Contra Costa Health (CCH), the broader health system in which CCHP is housed, is the largest department in Contra Costa County with more than 4,000 employees, providing integrated healthcare services and serving as the safety net for low‑income and uninsured residents.
Role Description
This is a full‑time, on‑site role for a Claims Manager (Patient Accounting Manager) at Contra Costa Health Plan located in Martinez, CA. The Claims Manager will oversee claims handling and processing operations, ensure efficiency and compliance with policies, and manage a team to maintain the accuracy and timeliness of claims activities. This role also involves analyzing claims data, addressing escalated issues, and working to improve claims management processes and systems in collaboration with internal teams.
Responsibilities
Managing and supervising claims operations for CCHP, including claims processing, adjustments, and payment integrity Selecting, training, evaluating, and monitoring the performance of subordinate personnel, including supervisors and clerical staff Overseeing workflows to ensure timely and accurate adjudication of claims across Medi‑Cal, Medicare, and commercial lines of business Serving as liaison with providers, county healthcare staff, and external stakeholders to resolve claims‑related issues Ensuring compliance with federal, state, and local regulations as well as managed care, Medi‑Cal, and Medicare standards Monitoring claims performance metrics, including timeliness, accuracy, and compliance with DHCS, DMHC requirements, and CMS Reporting key claims issues, trends, and operational updates to higher management in a timely manner Collaborating with Finance, Utilization Management, Compliance, and other divisions to align claims operations with organizational goals
Qualifications
Education: Possession of a Bachelor’s degree from an accredited college or university with a major in business administration, finance, accounting, health care administration or a closely related field Experience: Three (3) years of full‑time or its equivalent experience in an administrative, managerial or supervisory position with direct responsibility for delivery of patient business services, patient accounting services, insurance billing services, collection services or patient financial counseling services in a health care services organization Substitution for Education: Possession of an Associate’s Degree or successful completion of sixty (60) semester or ninety (90) quarter units from an accredited college or university, combined with two (2) years of full‑time additional qualifying experience, may be substituted for the required Bachelor’s degree; OR Possession and maintenance of one of the following professional certifications: Certified Healthcare Financial Professional (CHFP) issued by the Healthcare Finance Management Association (HFMA) or Certified Patient Account Manager (CPAM) or Certified Clinic Account Manager (CCAM) certifications issued by the American Association Of Healthcare Administrative Management (AAHAM); or Certified Patient Account Technician (CPAT) or Certified Clinic Account Technician (CCAT) combined with additional four (4) years of full‑time qualifying experience may be substituted for the required Bachelor’s degree Substitution for Experience and Education: Five (5) years of full‑time or its equivalent experience as an Account Clerk Supervisor in Contra Costa County may be substituted for the required education and experience
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Contra Costa Health is offering an excellent opportunity for two (2) Managers within Contra Costa Health Plan (CCHP)'s Claims Department. CCHP is a federally qualified, state‑licensed, and county‑sponsored Health Maintenance Organization (HMO) serving Contra Costa County in the East Bay of the San Francisco Bay Area. Established in 1973, CCHP was the first county‑sponsored HMO in the United States and today serves as the largest managed care health plan in Contra Costa County, covering more than 250,000 residents. Contra Costa Health (CCH), the broader health system in which CCHP is housed, is the largest department in Contra Costa County with more than 4,000 employees, providing integrated healthcare services and serving as the safety net for low‑income and uninsured residents.
Role Description
This is a full‑time, on‑site role for a Claims Manager (Patient Accounting Manager) at Contra Costa Health Plan located in Martinez, CA. The Claims Manager will oversee claims handling and processing operations, ensure efficiency and compliance with policies, and manage a team to maintain the accuracy and timeliness of claims activities. This role also involves analyzing claims data, addressing escalated issues, and working to improve claims management processes and systems in collaboration with internal teams.
Responsibilities
Managing and supervising claims operations for CCHP, including claims processing, adjustments, and payment integrity Selecting, training, evaluating, and monitoring the performance of subordinate personnel, including supervisors and clerical staff Overseeing workflows to ensure timely and accurate adjudication of claims across Medi‑Cal, Medicare, and commercial lines of business Serving as liaison with providers, county healthcare staff, and external stakeholders to resolve claims‑related issues Ensuring compliance with federal, state, and local regulations as well as managed care, Medi‑Cal, and Medicare standards Monitoring claims performance metrics, including timeliness, accuracy, and compliance with DHCS, DMHC requirements, and CMS Reporting key claims issues, trends, and operational updates to higher management in a timely manner Collaborating with Finance, Utilization Management, Compliance, and other divisions to align claims operations with organizational goals
Qualifications
Education: Possession of a Bachelor’s degree from an accredited college or university with a major in business administration, finance, accounting, health care administration or a closely related field Experience: Three (3) years of full‑time or its equivalent experience in an administrative, managerial or supervisory position with direct responsibility for delivery of patient business services, patient accounting services, insurance billing services, collection services or patient financial counseling services in a health care services organization Substitution for Education: Possession of an Associate’s Degree or successful completion of sixty (60) semester or ninety (90) quarter units from an accredited college or university, combined with two (2) years of full‑time additional qualifying experience, may be substituted for the required Bachelor’s degree; OR Possession and maintenance of one of the following professional certifications: Certified Healthcare Financial Professional (CHFP) issued by the Healthcare Finance Management Association (HFMA) or Certified Patient Account Manager (CPAM) or Certified Clinic Account Manager (CCAM) certifications issued by the American Association Of Healthcare Administrative Management (AAHAM); or Certified Patient Account Technician (CPAT) or Certified Clinic Account Technician (CCAT) combined with additional four (4) years of full‑time qualifying experience may be substituted for the required Bachelor’s degree Substitution for Experience and Education: Five (5) years of full‑time or its equivalent experience as an Account Clerk Supervisor in Contra Costa County may be substituted for the required education and experience
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