Job Description

Consultis, a premier Technical and Professional Recruiting Firm with the single focus of pairing the right candidate with the right employment opportunity is currently searching for a Medical Claims Manager for a Direct Hire opportunity (FTE) with a fast-growing healthcare company in San Antonio, Texas. Key Responsibilities:

• Oversee Managed Care Claims adjudication and manage the medical claims department, contributing to company growth while uploading Mission, Vision and Values
• Participate in budget preparation and inter-departmental activities.
• Handle inbound and outbound medical claims processing (835, 837, EFT, etc)
• Manage staff performance, including coaching and corrective actions.
• Develop and update departmental procedures and policies.
• Implement policy and regulatory changes, and maintain quality control standards.
• Supervise workflow coordination and staff assignments.
• Manage delegated claims audit and compliance.
• Address escalated issues and provide guidance.
• Perform other assigned duties. Experience:
• Minimum 5 years of medical claims adjudication experience, including 3 years in a managerial role.
• Proficient in Medicare guidelines and healthcare claims regulations.
• Prior experience with Delegated Medicare Advantage and claims adjudication software. Education:
• Bachelor’s Degree preferred, or equivalent relevant experience. Skills & Abilities:
• Strong knowledge of Medicare guidelines and healthcare claims regulations. Work Hours & Travel:
• Monday to Friday, 8:00 a.m. to 5:00 p.m., with flexibility for project needs.
• Travel to local medical offices may be required

• WE ARE UNABLE TO OFFER SPONSORSHIP OR THIRD-PARTY REPRESENTATION FOR THIS POSITION.