Job: Medical Claims Manager

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Posted: 05/15/2017

Job Status: Full Time

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.

This position has been created in response to the business intelligence needs associated with the practice’s significant growth and complexity. This position Reports to the Business Office Director. Pay equal to or higher than a billing manager in a mid-sized practice.

To be considered for this new and exciting opportunity, you must have a minimum of 10-15 years of revenue cycle/claims billing management experience in the medical group practice industry as the director or manager of a 10+ physician medical group practice business office. 

  • You must be able to demonstrate clear knowledge of the billing, Charge entry and collection cycle management.   
  • You must also be able to demonstrate a track record of critical thinking, analytical acumen, written and verbal communication skills, and reporting skills.    
  • Must be able to mentor, direct and train a large staff.  Experience in oncology /Radiation very desirable but not essential.

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
  • Understanding of Drug compendia.
  • Understanding of Research charges.
  • Ability to assist Audit Manager in accounting drug inventory errors with practice management system for accurate billing.
  • Ability to perform audits of the department in all specialties.
  • 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.
  • Complete all daily, weekly and monthly checklists and benchmarks. Weekly to management.
  • Oversight in capture of all inpatient and outpatient procedures, supplies, drugs, procedures, medical oncology, radiation oncology, Urology, Breast Surgery, GYN Surgery Departments diagnosis and conditions in the PM system. 
  • Ability to direct all aspects of the charge capture and evaluate and articulate areas of necessary change.
  • Ability to provide leadership across the business office
  • Other duties as assigned by management team.

Knowledge and Skills:

  • Knowledge of PQRI codes for oncology, radiation, surgical a plus.
  • Working Knowledge of Excel and ability to create reports and translate into meaningful tools
  • 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 billing & 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:

  • 10-15 years of medical reimbursement billing experience.
  • 5-10 years of management experience.
  • Extensive charge entry experience through claims processing at clearinghouse.
  • CPC Coder a plus.
  • Expanded education required.  Bachelor's Degree preferred but not essential. 

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 www.ironwoodcrc.com. "Outsmarting Cancer One Patient at a Time"

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