Responsibilities Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
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Job Summary: The Senior Claims Manager will oversee and ensure the efficiency and accuracy of healthcare claims operations. This position oversees the claims inventory by setting, evaluating, and monitoring the claims inventory and examiner production metrics and is responsible for timely and precise benefit determinations for claims, while upholding exceptional service standards for both members and providers. The Senior Manager will spearhead implementation efforts and advocate for excellence in quality processes and compliance standards. The role will proactively identify areas for improvement, provide coaching to team members and ensure the attainment of key performance metrics. This position will participate in various meetings. Company initiatives and other workgroups to support claims integrity. Additional responsibilities include all aspects of running an efficient team, including hiring, managing, coaching, training, and motivating direct reports.
Benefit Highlights: Loan Forgiveness Program Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com About Universal Health Services: One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
Qualifications Qualifications and Requirements: Bachelor's degree in health care administration or business management, or equivalent work experience. 5+ years' experience with a health care company or a health plan. 5+ years' experience managing, budgeting, forecasting and collaboration with executive leadership. Strong leadership skills with an ability to influence and persuade internally and externally while driving cross-functional collaboration. In-depth knowledge of medical terminology, coding systems (CPT, ICD-10), and insurance billing practices. Strong understanding of healthcare regulations, including HIPAA, CMS guidelines, state laws and experience in information preparation for required regulatory audits. Ability to promote data driven decision making throughout the organization. Knowledge of benefits, pricing and inventory management and reporting. Expertise in software implementation, technology adoption and an understanding of which tools work best to meet the needs of organization. Outstanding interpersonal skills Excellent written, oral, and active listening communication skills. Proficient in MS Office, contact center and training platforms, workforce management and project/team management software. Strong project management skills and experience managing large scale projects. QNXT system experience preferred. Ability to effectively communicate in English, both verbally and in writing. Excellent computer skills. Highly developed professional, interpersonal, written and oral communication skills. Experience in building and maintain provider relationships. Highly accountable, organized, detailed Ability to develop and implement strategic initiatives. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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If you would like to learn more about the opportunity, please contact Bridget Gomez at:
