Manager, Reconciliation

American Specialty Health, Inc. is seeking a Manager, RCN to join our Reconciliation department. This position will oversee the 2-step claim reconciliation process and related functions as well as meet all performance standards and established goals of the organizations.

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Responsibilities

  • Develops, manages, evaluates and is responsible for all activities within assigned scope of authority. Ensures accuracy and productivity achieves/exceeds company standards.
  • Plans and directs workflow to staff.
  • Monitors quality and production standards; evaluates workflow and reporting systems to ensure claims are reconciled on a timely and accurate basis.
  • Assists staff in resolving technical issues, process bottlenecks and resource allocation situations.
  • Sets goals and objectives for the department and staff; ensures that department results meet/exceed department performance standards.
  • Prepares routine reports of department results, goals, service levels, resources and challenges.
  • Provides leadership and motivation by establishing clear expectations and goals.
  • Provides client support for new implementations and ongoing business as it relates to the 2-step claim process and file requirements and needs.
  • Evaluates staffing and resource needs and makes recommendations to manager.
  • Recruits, interviews and recommends the hiring of new staff members.
  • Evaluates performance, provides constructive feedback, conducts counseling and training sessions, and supports staff in the accomplishment of assigned objectives and projects.
  • Reviews and approves expenses within scope of authority.
  • Supports corporate quality improvement processes and ensures compliance with regulatory, accreditation, and health plan delegation standards.
  • Recognizes unique and/or problem situations within assigned area of responsibility, researches and formulates solutions in conjunction with manager.
  • Maintains confidentiality of all member, provider, client and proprietary information.
  • Participates with other members of management to discuss, develop, and implement operational and organization processes within the company.
  • Represents Reconciliation when establishing and analyzing new and existing processes.
  • Provides recommendations and input in developing organizational goals, strategies, budgets and other long- and short-term planning matters.
  • Works with Information Systems to enhance automation and system efficiencies.
  • Serves on committees, workgroups, and project teams as assigned.
  • Ensures that proper training is completed, and ongoing meetings are conducted.
  • Supports inter-departmental communication and teamwork to accomplish corporate objectives.

Qualifications

  • Bachelor’s degree in Business or equivalent experience.  If equivalent experience, high school diploma required.
  • Minimum five years of progressive claims experience, three of which have been in a supervisory or management capacity.
  • Thorough understanding of Managed Care (HMO, PPO, POS and related plans).
  • Experience with and knowledge of ASH internal systems (IHIS) preferred.
  • Familiarity with Managed Care, HMO, PPO plan provisions.
  • Knowledge of Centers for Medicare and Medicaid Services (CMS) regulations, HCFA regulations, medical terminology, CPT and ICD-9 coding, and claims best practices.
  • Proficient in MS Office; with experience in word processing, spreadsheets, email and related software systems.
  • Strong project management, organization, customer service, problem-solving and verbal/written skills.

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Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. 

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.