Director, Claims Administration

About this opportunity:

Workplace Options is proud to support our sister organisation, Behavioral Health Systems (BHS), in
recruiting a Director, Claims Administration. Reporting to the Vice President, Finance this position is responsible for directing all claims administration for BHS. Directly supervises and is responsible for departmental staff and operations.

BHS operates one of the nation’s largest specialty preferred provider organizations (PPO), which is comprised of psychiatrists, psychologists, social workers, EAP providers as well as facility networks including hospitals, rehab/residential treatment centers, partial hospitalization programs and intensive outpatient programs. BHS fully credentials and panels their own network of providers.

Current Opportunity: Director, Claims Administration

Location: Alabama (Birmingham)

Full-time/Part-time: This is a full-time (40 hours per week) position.

Responsibilities:

• Directs and oversees the operations of all claims administration functions, including accurate efficient data entry, at BHS to meet the company’s operational and financial requirements
• Provides direction, supervision and support to all claims staff. Responsible for retaining valued staff and replacing or hiring critical staff when applicable. Develop staff capabilities to ensure coverage, cross-training and ongoing development through evaluation and continuous feedback.
• Plans, develops and implements projects, processes and technology to continuously improve and manage all claims administration operations and all related processes to continuously improve and manage its cycles and increase profitability.
• Manages and directs the systems and processes for efficient and accurate claim reporting, billing and processing. Responsible for working with CIO and other IT staff on process improvement and optimizing the use of technology to automate. If applicable, lead installation of new or revised in-house claims systems.
• Collects, organizes, analyzes and disseminates data reporting from various sources to management on a regular basis with attention to detail and accuracy including timeliness. Monitors reporting and escalates issues to VP, Finance.
• Prepare quarterly and/or annual reports for clients. Responsible for pulling appropriate reports from a variety of software applications, analyzing data and preparing written comments. Keep abreast of client cost and advise other departments appropriately.
• Prepare departmental objectives, goals, workforce plans, budgets and maintain updated policies and procedures. Review annually and make recommendations as deemed appropriate.
• Recruit and supervise data entry staff as appropriate.
• Responsible for revenue analysis in conjunction with the accounting department.
• Responsible for adherence to the no surprises act regarding payment calculations.
• Perform other related duties as directed or deemed appropriate. Attend meetings as requested.

Qualifications:

• Bachelors in Accounting or a related field;
• Five years insurance and/or healthcare experience required, preferably with billing and/or claims experience;
• Experience/involvement in mental health field preferred;
• Very strong proficiency with computerized applications (Word, Access, Excel); must be advanced or expert level skill in MS Excel.
• Experience managing projects for improving processes or implementing new systems for billing and other related business processes.
• Excellent communication skills (written and oral) and organizational skills.

For further information about BHS please see

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