Medical Claims Director

$60,000 - $80,000/Yr

Turn Key Health Clinics - Oklahoma City, OK

Full-time - Senior

Oklahoma City, OK

Ambulatory Health Care Services

About the position

The Medical Claims Director at Turn Key Health Clinics LLC is responsible for overseeing the strategic processing of medical claims within a correctional healthcare environment. This role involves ensuring compliance with federal, state, and local regulations while managing a team dedicated to timely claims processing. The position requires strong leadership skills and the ability to build relationships with various stakeholders in the healthcare and correctional sectors.

Responsibilities

• Obtain knowledge on correctional medical claims processing, including researching new legislation and guidelines.
• Work with the legal team to address and research regulatory requirements related to claims.
• Manage day-to-day activities of the claims team and ensure timely processing of medical claims.
• Develop and adhere to department policies and procedures that align with company needs.
• Build and maintain relationships with healthcare institutes, correctional partners, and other team members.
• Coordinate necessary communication for all affected parties related to claims issues.
• Monitor claim activities, performance management, and production standards and quality of results.
• Work with the accounting department to ensure proper payment processing.
• Produce monthly reports and share with appropriate parties in a timely manner.
• Process claims as needed.

Requirements

• 5 plus years of medical claims processing experience required.
• Bachelor's Degree in a related field (preferred).
• Knowledge of Federal, State, and County regulations and laws regarding medical claims (correctional knowledge a bonus).
• Management experience (preferred).
• Knowledge of Medicaid claims processing (preferred).