Sr. Manager of Claims Operations

Position: Sr. Manager of Claims Operations

Job Type: Full Time

Location: Remote - Remote (Residence in Colorado preferred)

Compensation: $70,000-85,000 Annual Salary + Incentives

About The Role

We are seeking a highly skilled Senior Manager of Claims Operations to oversee the daily billing and claims management operations. This role is ideal for someone who thrives in a data-driven, hands-on managerial position and is committed to driving efficiency and accuracy in billing and collections processes. The successful candidate will have a strong process orientation and drive to win on behalf of the organization and patients.

Billing Collections:

• Oversee the entire billing cycle, ensuring claims are processed timely by following established protocols, attention to key detail and ensuring effective prioritization and escalation
• Understand requirements and build relationships with insurance payors to meet needs and optimize timely, friction free payment
• Process insurance claims for private and employer insurance reimbursement
• Process and follow up on payor denials, consulting with the client and/or family as needed
• Utilize data to identify and address root causes of payor denials
• Manage and intervene as needed for complex claim denials
• Manage and hold team accountable to specific performance metrics
• Post payments in a timely manner

Quality Compliance:

• Complete necessary documentation, timely entries into the records, and maintain compliance with overall documentation
• Assist in preparing documents for annual billing audits
• Ensure that all financial records meet audit and compliance standards and help maintain adherence to regulatory and payor requirements

Team Leadership Training:

• Recruit team members where possible with Mental Health / Substance Abuse billing coding experience
• Record attendance in billing software for services performed to submit claims
• Onboard new billing staff and ensuring they receive thorough training on procedures and performance expectation
• Provide ongoing support to the team and help them stay up to date with new billing functions

Collaboration Communication:

• Collaborate with other departments, including working closely with Billing Operations, Benefits Verification, and Director of Revenue Operations to reconcile billing reports
• Responsible for providing regular billing reports, including weekly and monthly summaries of billing, accrual, and denial totals to the Director of Revenue Operations and other key stakeholders
• Assist in reconciling billing data with the financial subledger to ensure accuracy
• Participate on committees and in professional meetings and staffing as necessary for the functions of the program
• Provides supportive leadership for community meetings and selected off-campus activities
• Participates in marketing activities
• Continuous Process Improvement:
• Play a key role in identifying opportunities to improve efficiency in billing processes
• Make recommendations for streamlining operations and contribute to ongoing improvements to better support the billing team
• Participates in the facility-wide Performance Improvement Program
• Other duties as assigned

Qualifications

Education Requirements:

• High school diploma/GED required
• Bachelor’s degree in a related field preferred or equivalent experience
• Coding certificate or associate’s degree in business administration or health care administration preferred

Experience Requirements:

• 4+ years of experience in healthcare billings and claims
• 2+ years of experience in leading a team
• Experience working with out of network and other complex claims adjudication
• Must have valid driver's license
• Work closely with all members of treatment team to assure positive working relationships
• Must consistently demonstrate the ability to establish and maintain good public relations with families, referral agencies, and other community resources
• Must have the ability to express ideas clearly, concisely, convincingly, and effectively when addressing an audience
• Consistently exercise good judgment and adequate emotional stability in evaluating situations and making decisions despite the pressures of deadlines or the occurrence of unexpected stressful events

Other Requirements:

• Candidates applying for this position should be aware that an offer for employment in this position is contingent upon passing a comprehensive background check, encompassing criminal records and motor vehicle reports.

The Perks

At Sandstone Care, we believe that great care starts with our employees. That’s why we offer a comprehensive benefits packageto support you in your personal and professional journey. Some of the benefits include:

• A competitive compensation and total rewards package including meaningful salary, bonus incentive programs, merit-based pay increases, and professional growth opportunities.
• A 401k program with 5% company match and competitive vesting schedule
• An unlimited PTO package that affords you the flexibility needed for work/life harmony in a dynamic role.
• High quality medical, dental, and vision insurance with a variety of package options that meet your needs and majority company paid.
• A robust Employee Assistance Program: Including counseling, legal consultations, financial planning, and wellness coaching.
• A collaborative and supportive community of therapists and team members: Fostering a positive work environment.

What to Expect: Our Interview Process

Here's an overview of what comes next:

1. Application Review: We'll promptly review your application within one business day.
2. Discovery Call: Expect a 30-minute discovery call with one of our recruiters.
3. Onsite Interview: You'll have 1-2 subsequent interviews with our Revenue Cycle Management Leadership.
4. Offer: If all goes well, you'll receive an offer. (All offers will be contingent on a successful background check)

Expected Interview Timeline: The entire process typically takes 2-3 weeks.

Sandstone Care’s Commitment to Diversity, Equity, Inclusion

At Sandstone Care, we are committed to fostering a culture of diversity, equity, and inclusion that not only enriches the lives of our employees but also ensures the wellbeing and care of our clients, regardless of their race, ethnicity, gender identity, sexual orientation, socioeconomic status, age, ability, or background. We believe that embracing diversity and promoting equity and inclusion are integral to our mission of providing high-quality behavioral health services.

Sandstone Care is an equal opportunity employer and prohibits discrimination and harassment of any kind. We are committed to creating a diverse and inclusive workplace where all employees feel valued, respected, and empowered. We do not discriminate based on race, color, religion, creed, age, sex, national origin, ancestry, marital status, veteran status, sexual orientation, gender identity, disability, or any other legally protected status. All employment decisions are based on qualifications, merit, and business needs.