9901 - Signature Advantage
9901 – Signature Advantage
Louisville, KY, US, 40299
Signature HealthCARE is a family-based healthcare company that offers integrated services in 10 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, home health, cognitive care, and telemedicine.
Signature Advantage, a subsidiary of Signature Healthcare, is an Institutional Special Needs Plans (I-SNP) which is a Medicare Advantage Plan. As an I-SNP, we provide a Medicare Advantage plan for people who are eligible for Medicare and who reside in our partner nursing facilities.
Our Sacred Seven Values of Heroic, Compassion, Teamwork, Respect, Integrity, Patience and Positivity make this an incredible place to serve and make a difference in the lives of our patients, residents, Stakeholders and communities!
How you will make a difference:
* The Claims Manager is responsible for accuracy and coordination of Claims Set up with TPA offices
* Ensures plan meets standards for Claims Adjudication.
* Identify risks and ensure processing of all claims per CMS guidelines
How you will spend your time:
* Analyze claims to ensure optimal quality and coordinate with CFO for check run approvals
* Review and analyze provider disputes
* Perform root cause analysis of claims payment discrepancies
* Conduct post payment coding reviews
* Completes audits on accuracy of claims system set-up and manage payment cycle to ensure compliance to contract requirements.
* Participate in workgroups to help resolve complex payment issues involving claims configuration, health services, network and contracting
* Ability to interpret coding guidelines, CMS regulations, reimbursement, Medicare Claim Processing for accurate application of policy to claim edits and audits.
* Other special projects and duties, as assigned.
* Analyze complaint, appeal, dispute, and grievance data, as it relates to claims, develop trend reports and work with various committees to identify opportunities for improvement and increase member and provider satisfaction.
* Oversee the investigation and resolution of provider claim disputes/appeals.
The qualifications you will need:
* Knowledge and experience
* Demonstrated intermediate to advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation.
* Highest level of professionalism with the ability to maintain confidentiality.
* Ability to communicate at all levels of organization and work well within a team environment in support of company objectives.
* Customer service oriented with the ability to work well under pressure.
* Strong attention to detail and accuracy, excellent organization skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
* Strong analytical and problem-solving skills.
* Ability to take initiative and make suggestions for improvements.
* Ability to work with minimal supervision, take initiative and make independent decisions.
* Ability to deal with new tasks without the benefit of written procedures.
* Approachable flexible and adaptable to change.
* Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.
Your work environment:
* You’ll work mostly indoors on floors that are tiled or carpeted.
* You’ll be around other co-workers, and their guests.
* You’ll have possible exposure to occasional slippery floors, chemicals, sharp objects, and hazardous materials and waste (including human), blood borne pathogens, and communicable diseases.
Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer – Minority / Female / Disability / Veteran and other protected categories.: