Claims Director

Role Overview

• Provide leadership, direction and management of the department
• Gather, research and analyze various data to aid Executive Management in decisions regarding provider services
• Ensure the identification of Medicaid and state funded covered services including retroactive Medicaid coverage to ensure appropriate enrollment and claims payment
• Interact with providers and department staff to address any enrollment, payment and billing issues
• Assist in ensuring that reimbursement tables in the claim’s software remain current
• Develop and implement solutions for claims management

Requirements

• Bachelor’s degree and three (3) years’ experience with extensive medical claims filing, coding, data reporting, and financial analysis.
• Knowledge of Professional (Form CMS1500) and Institutional (UB04) billing forms, ICD-10/CPT/HCPCS coding/CAQH, HIPAA and claims processing.
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.
• Preferred: Degree in Business field and/or Master’s degree
• Supervision of two (2) or more employees
• Experience with NC Medicaid
• One or more of the following: Certified Professional Coder (CPC), Certified Coding Associate (CCA), Certified Outpatient Coder (COC) & Certified Inpatient Coder (CIC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist (CCS)

Benefits

• Health Insurance with no premium for employee coverage
• Flexible Spending Accounts
• 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
• NC Local Government Retirement Pension (defined-benefit plan)
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies