VillageCare Seeks Manager for Healthcare Claims to Optimize Audit Processes in New York
VillageCare, a community-based, not-for-profit organization in New York City, is actively seeking a Manager for Claims Healthcare. This role is crucial for developing strategies to optimize the claims audit and review process. The manager will be responsible for overseeing the completion of claims audits and reviews of delegated vendors, ensuring compliance with health plan and regulatory standards, as well as internal policies. Additionally, the position involves monitoring key performance indicators (KPIs) to guarantee accurate and timely claims processing. The successful candidate will also ensure that third parties adhere to agreed-upon delegated authority contracts and performance standards. This role requires a minimum of five years of experience in claims analytics, with at least two years in managing and training staff within a healthcare setting. Knowledge of medical terminology, ICD-10, CPT, HCPCS coding, CMS guidelines, and Encoder Pro is essential. 
