Job: Claims Manager

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Job Description

Ironwood Cancer & Research Centers has beautiful state-of-the-art integrated Cancer and Breast Centers, with locations strategically located throughout the Valley. Each one provides a superior cancer care environment with a full spectrum of cancer related services for patients. Our multi-disciplinary team approach includes surgical oncology, medical oncology, radiation oncology, diagnostic imaging services, social service support, nutritionist, integrative services, and genetic counseling.

Mission Statement: To serve the community by providing quality, comprehensive cancer care which respects the values and needs of each individual.

Overview: We are looking for a motivated, professional, and friendly individual to work as a Claims Manager at our Central Business Office located in Gilbert.

Essential Duties and Responsibilities:

  • Along with Claims Supervisor, supervise Charge Capture specialists and Coder I. Ensure that all functions are completed as needed.
  • Ensure that all the claims are received by clearinghouse and payers. Accounts for all claims posted to claims sent.
  • Able to work the technical end with our vendors and our practice management system to ensure all claims were rec’d at the payer departments.
  • Ability to assist in the training of charge capture staff, authorization/insurance verification, AR staff and others as needed
  • Ability to review all questions for off-label use, checking approved compendias. Alerting manager or administrator.
  • Ability to post Research charges.
  • Ability to assist Audit Manager in accounting drug inventory errors with practice management system for accurate billing.
  • Ability to post the Drug Replacement patients for accurate billing.
  • Audit Radiation charges for accurate billing.
  • Monitor the auditing of staff weekly creating benchmarks with Claims Supervisor
  • Maintain appropriate documents, reports and files in order to comply with all applicable laws and policies.
  • Initiate and process charge and diagnosis corrections. Identify charge and coding discrepancies and confer with internal or external parties to resolve.
  • Complete all daily, weekly and monthly checklists. Weekly to management.
  • Ability to capture all inpatient and outpatient procedures, supplies, drugs, procedures, medical oncology, radiation oncology, diagnosis and conditions in the practice management system as needed.
  • Ability to post clean claims to clearinghouse, working clearinghouse rejections
  • Other duties as assigned by management team.

Knowledge and Skills:

  • Knowledge of PQRI codes for oncology.
  • Knowledge of chemotherapy related drugs, supplies utilized and SNF, LTC and Hospice in relation to insurance benefits.
  • Knowledge of CPT, ICD-9, and HCPCS required. CPC coder a plus.
  • Knowledge of governmental, legal and regulatory provisions related to collection activities.
  • Proficiency in Microsoft Office Suite products, Internet browsing and medical practice management software.
  • Able to be in a seated position, talk on the phone, repetitive keyboard usage and clarity of vision at 20 inches or less.

Education and Experience:

  • 5 year minimum of medical reimbursement billing experience.
  • 3 years of Supervisory experience.
  • Expanded education required. College degree a plus.

We offer a competitive salary and a comprehensive benefit package including health/dental/vision and life insurance, 401K, and a caring work environment. We are an E.O.E.

Please visit our website at "Outsmarting Cancer One Patient at a Time"