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Tracker RMS

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.

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    • Job type: Full-time
    • Location: San Antonio
    • Date posted: