Claims Director

Role Overview

• Provide leadership, direction and management of the department
• Responsible for gathering, researching and analyzing various data to aid Executive Management in decisions regarding provider services
• Responsible for ensuring the identification of Medicaid and state funded covered services including retroactive Medicaid coverage to ensure appropriate enrollment and claims payment
• Responsible for interaction between providers and department staff to address any enrollment, payment and billing issues
• Responsible for maintaining an understanding of the entire claims management/AR system
• Responsible for maintaining an understanding of Medicaid and State funded billing rules

Requirements

• Bachelor’s degree in a business field
• Minimum of three (3) years’ experience with extensive claims filing, data reporting, and financial analysis
• Knowledge of Professional (Form CMS1500) Institutional (UB04) billing form, ICD-10/CPT/HCPCS coding/CAQH, HIPAA and claims processing
• Valid driver’s license
• Must reside within North Carolina
• Must be able to travel within catchment as required
• Master’s degree in related business field (preferred)
• Supervision of two (2) or more employees (preferred)

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