Maintains supervision of the day to day claims processing function for the Denver Health Medical Plan. Trains claims business analysts to ensure accurate processing of claims. Educates regarding subrogation and coordination of benefits. Reviews claims adjudication for timeliness and accuracy of payment. Educates claims business analysts regarding contract terms. Interfaces with other personnel within the Managed Care Division to assist with extraction of accurate claim information for reporting purposes. Interfaces with Managed Care Information Systems regarding system changes and data extraction.
Education 1. Bachelor’s degree required.
Experience 1. Five years of health care claims experience required. 2. Experience in Medicaid, Medicare, and Commercial lines of business preferred. 3. Two years of lead or supervisory experience required.
Knowledge, Skills and Abilities 1. Fluent understanding of HCPC codes, UB 04 forms, HCFA 1500 forms, RBRVS fee schedules, and other common claim coding conventions. 2. Understanding of NAIC coordination of benefit rules. 3. Excellent verbal and written communication skills. 4. Demonstration of good supervisory skills. 5. Knowledge of general report writing. 6. Ability to work independently and collaboratively, generate creative ideas for interventions with other internal and external team members to ensure timelines are met
Computers and Technology 1. Proficient in Microsoft Suite
Internal Number: 52890
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.