Healthcare Claims Operations Director at Boston

Job Description

Overall Responsibilities:

PCG is currently seeking a candidate to:

• Lead/Co-lead Claims Operations staff
• Direct all phases of claims processing to ensure that production standards, quality, and cycle times are maintained.
• Analyze existing operations and implement the necessary strategies, formal business practices, and technology to improve operational efficiency, productivity, and bottom-line results.
• Develop and implement strategic plans to achieve peak performance and ensure that goals are met in the areas of claims inventory, cycle time, quality, and budget parameters.
• Evaluate efficiency of existing business process and implement solutions for improvement.
• Facilitate root cause analysis, project scope and requirements documentation for complex business system solutions.
• Prepare periodic reports that detail performance, initiatives, and overall departmental progress.
• Develop training plans to ensure staff competencies.
• Investigate potential departmental errors and provide departmental and / or systemic remediation.
• Manage operations through industry leading project & program management standards
• Design, develop, and maintain companion guides for claims processing including management of provider training, education and testing.
• Escalate and resolve contract management issues
• Manage new product launches / system rollout
• Manage dynamic budgets and matrix organizational structure
• Conduct risk management & analysis

Required Skills:

• Strong organizational and quantitative skills.
• Strong analytical skills, including the ability to analyze, understand and summarize key issues.
• Expert in HIPAA standard transactions for electronic data interchange (EDI)
• Ability to work as a team player in a dynamic, team-oriented, deliverable-focused, and professional environment.
• Excellent oral and written communication skills.
• Proficiency in MS Office products - Excel, Word and Power Point.

Required Experience:

• A Bachelors Degree is required; Masters highly preferred.
• 10+ years of relevant work experience in a health care industry.
• Demonstrated initiative to stay abreast of current trends and technical advancements.

For more information on Public Consulting Group, please visit our website at www.pcgus.com

PCG is an equal opportunity employer.

Job Requirements

 
Country: USA, State: Massachusetts, City: Boston, Company: Public Consulting Group, Inc..