Claims Director directs and oversees the operations of an insurance claims department to meet operational, financial, and service requirements. Establishes policies and procedures for the administration of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Claims Director is responsible for the strategic processing and payment of claims. Maintains up-to-date- knowledge of legislation, regulations, and industry events which pertain to insurance claims. Additionally, Claims Director provides expert guidance and consultation to staff on the most complex claims. Requires a bachelor's degree. Typically reports to top management. The Claims Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)
Description
Employee’s Name: TBD Job Title: CFTSS and HCBS Claims Analyst
Supervisor: Director of CFTSS and HCBS Start Date: TBD
Department: CFTSS and HCBS FLSA Status: Full Time – Exempt
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GENERAL DESCRIPTION:
The CFTSS and HCBS Claims Analyst coordinates with the CFTSS and HCBS Payroll Clerk, Finance Director, and Managed Care Director to ensure all CFTSS and HCBS services are billed and adjudicated in accordance with New York State Department of Health (NYSDOH) and federal regulations. The CFTSS and HCBS Claims Analyst can work independently and efficiently under pressure. The CFTSS and HCBS Claims Analyst conducts follow-up correspondence to resolve open and/or denied claims. The CFTSS and HCBS Claims Analyst is a liaison between MDPYFS and the MMCPs (Medicaid Managed Care Plans) that insure the clients in our CFTSS and HCBS Program.
MAJOR DUTIES AND RESPONSIBILITIES:
Requirements
QUALIFICATIONS:
EDUCATION:
Bachelor’s Degree
EXPERIENCE:
At least two (2) years of administrative or supervisory experience
At least two (2) years of medical billing experience
Familiarity with billing and coding terminology
REQUIRED SKILLS AND ABILITIES:
Highly organized and detail-oriented
Business Acumen
Effective oral and written communication skills
Consultation
Relationship management
Time management
Data input
Ability to communicate effectively with stakeholders
Understanding and incorporation of the Lasallian Culture of Care as a work philosophy
Ability to work varying hours as needed
Proficient computer skills (Microsoft Word & Excel)
Excellent problem-solving capability and ability to meet multiple deadlines under pressure
ACTIVE CERTIFICATIONS:
Mandated Reporter
Lasallian Culture of Care (LCC)
Required training as delineated by the oversight agency and or MDPYFS
SUPERVISORY RESPONSIBILITY:
This position may serve as a consultant and mentor in the agency.
EXPECTED HOURS OF WORK:
The number of days will vary based on the agreed work schedule. The hours of work are up to forty (40) hours per week. This position may require long hours and occasional weekend work as the job demands.
BACKGROUND VERIFICATION and CLEARANCE:
Section 424-A of the New York Social Services Law requires an authorized agency to inquire whether a candidate for employment with child-caring responsibilities has been the subject of a child abuse and maltreatment report.
Credential Verification
Medical and Physical clearance, which includes TB screening
State Central Registry (SCR) Clearance
Staff Exclusion List (SEL)
Justice Center Background Check
Required training as delineated by the oversight agency and or MDPYFS
Reference Verification
PHYSICAL REQUIREMENT:
Lifting requirement of 50 Lbs.
Ability to meet physical requirements of the position when performing the following: standing, walking, sitting, bending, stooping, squatting, kneeling, and climbing.
SALARY: $60,000 - $70,000
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