Director of Medical Claims
Peyton Resource GroupSan Antonio, Texas Metropolitan Area, United Statesjob_description.job_card.variable_hours_ago
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- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionLead the Claims department, ensuring compliance with Medicare Advantage, managed care delegation, company policies, and regulatory requirements. Define and execute strategic goals to enhance claims accuracy, timeliness, efficiency, and alignment with organizational objectives. Manage, develop, and evaluate staff : set expectations, conduct performance reviews, coach, and address performance issues. Establish, maintain, and update policies, procedures, and productivity standards that guide departmental operations.
Experience
- 10 years in healthcare claims or revenue cycle management with at least 5 years of managerial experience.
- Strong analytical and problem-solving skills, with the ability to independently learn new concepts and apply them effectively.
- Ability to review, interpret, and validate complex reports and data sets.
- Excellent communication and interpersonal skills, with a focus on collaboration, team development, and influencing without direct authority.
- Medicare guidelines and healthcare claims regulation knowledge.
- Medicare Advantage claims adjudication is a plus.
- Familiarity with delegated claims audits and payer compliance requirements preferred.
- Proficiency in claims systems (e.g., EZCap, EZEDI, or similar) and Microsoft Excel. Experience with EMR software is a must.
Essential Job Duties & Responsibilities
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Medical Director • San Antonio, Texas Metropolitan Area, United States
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