Medical Claims Manager

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Medical Claims Manager to join our growing team.

Job Summary: The purpose of this position is to manage the Medical Claims Review team and work closely with team members and clients with respect to billing and documentation policies, procedures, regulations, and requests for clarification for inconsistent, debatable, or non-specific documentation.

Responsibilities:

• Allocates resources and monitors projects to ensure that timelines and budgets are met.
• Establishes confidentiality, privacy, and security procedures for protected health information (PHI) records.
• Reviews medical charts and adjudicates claims while ensuring that all regulations are met in a timely manner.
• Performs highly complex tasks that are vital to the organization.
• Identifies and escalates program risks and issues to leadership and assists in issue resolution.
• Oversees claims review prior to payment, resulting in initial determinations.
• Oversees the activities related to reviewing, researching, investigating and replying to inquiries concerning compliance, inappropriate coding, denials, and billable services.
• Ensures that deadlines are met, and Medical Claims Review goals are achieved.
• Formulates strategic plans to develop, maintain, update, and resolve issues.
• Demonstrates knowledge of operations process, best practices, and procedures, and applies them to projects to ensure that operations objectives are achieved.
• Partners with customers to analyze issues and problems from the customer perspective.
• Oversees and provides customer-facing presentations.
• Manages complex internal and external customer relationships for long‑term value.
• Ensures strong customer service focus across Medical Claims Review.
• Provides direct support to customers often.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications

• High School Diploma or GED equivalent
• 8+ years of experience in a healthcare environment
• 5+ years of experience in billing procedures

Preferred Qualifications

• Knowledge of auditing concepts and principles
• Knowledge of team function within the organization
• Understanding of SharePoint applications, Webex, Skype, etc.
• Knowledge of Microsoft Word, Excel, and Visio, with a working knowledge of the rest of the Microsoft Office suite of applications
• Demonstrated expertise in managing diverse customer needs
• Ability to participate as a team member fostering collaborative decision-making
• Strong analytical and problem‑solving skills

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off,…