Manager of Claim Data Management
Job Locations US-CA-Los Angeles
Req No 2019-9278 Category Managed Care Type Regular Full-Time
The Manager of Claim/Provider Data Management is integral part of the organizations Managed Care Division’s leadership team. He or she is responsible for projecting and integrating the Mission and Core Values of the organization in the provision of provider data management services to internal and external customers of the Managed Care Division. In addition to overseeing the day-to-day operations of the Provider Data Management Department, he or she is responsible for and directs the configuration of the organization’s provider management system for the accurate and compliant adjudication of claims from the organization, Medicare and Medicaid health plans, Ryan White Care Act (RWCA) programs and wellness and prevention (sexually transmitted disease testing) programs. The Manager of Claim/Provider Data Management is responsible for management of the claims suspense/errors file.
The Manager of Claim/Provider Data Management leads the PDM staff by connecting its daily activities to the mission and core values of the organization to deliver a positive experience to contracted and non-participating medical providers and provider groups and the Department of Medicine and Public Health Division. He or she develops and implements the organization’s contracts and fee schedules that meet national claims adjudication standards and best practices and standards required by the Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services, Florida Agency for Health Care Administration, and state-issued standards where AHF operates a healthcare center or where the organization will operate a health plan in the future. He or she is responsible to oversee the claims pre-processing vendors.
The Manager of Claim/Provider Data Management is responsible for implementing and adhering to Management Philosophy of mission driven, fairness, learning, hands-on, accountability and tenacity in the leadership of Claims Department. He or she contributes to the organization’s success.
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