Full-Time Claims Administrator
Mecklenburg County is more than just a great place to work. The County provides an environment where you can touch and enrich lives every day in countless ways. From helping families in need to protecting the public’s health and even maintaining hundreds of acres of public park land, working here means you will have the chance to be a part of providing services for an amazingly diverse population.
It’s not just a place to work – for some, it’s an opportunity to serve their neighbors and make a difference in our community. For others, the role they take on fulfills a lifelong pursuit in an area of study. Whatever the reason you choose to work for the County, there is an opportunity for personal growth, professional development, and to truly make a difference in people’s lives.
JOB SPECIFIC INFORMATION
The Claims Administrator collaborates with Mecklenburg County Health Department to address the impact of, transition to, and optimization of new electronic health records systems on claims and revenue cycle management.
•Establishes and maintains a revenue cycle data dashboard, which houses various critical data elements specific to each line of business.
•Collects, analyzes, and summarizes information and medical trends in order to prepare standard and ad hoc financial reports.
•Responsible for process improvement within claims department and working with other departments to improve interdepartmental processes impacting claims workflows and productivity. Utilizes lean methodologies for continuous improvement.
•Serves as a key advisor to the Mecklenburg County Health Department on Medicaid/Medicare revenue enhancement and cost controls
•Supports and mentors’ staff in insurance resources, standards, data, and contracts.
•Interprets and ensures compliance with program policies, procedures and standards
•Works to prepare or supervise the preparation of processes and bill presentation to ensure quality and accuracy
Responsible for the coordination of multiple service areas within a County division of a large department.
• Displays line authority in making decisions on the day-to-day operations of the division.
• Integrates and coordinates service areas.
• Reviews and makes recommendations on statutes.
• Interpret policies and procedures.
• Serves as division liaison, both internally and externally.
• Manages division resources.
• Ensures compliance with statutory responsibilities and directives.
• Reviews reports submitted by staff members to recommend approval or to suggest changes.
• Delivers speeches, writes articles, or presents information at meetings or conventions to promote services, exchange ideas, or accomplish objectives.
• Interprets and explains policies, rules, regulations, or laws to organizations, government or corporate officials, or individuals.
• Prepares or presents reports concerning activities, expenses, budgets, government statutes or rulings, or other items affecting businesses or program services.
• Serves as liaisons between organizations, shareholders, and outside organizations.
• Establishes departmental responsibilities and coordinates functions among divisions and worksites.
Experience: Six years of progressively responsible experience directly related to the area assigned.
Education: Bachelor’s Degree in a related field.
Combination of relevant education and relevant experience accepted? Yes
Licenses and Certifications: Valid NC or SC driver’s license and the ability to obtain and maintain a County Operator Permit.
KNOWLEDGE, SKILLS AND ABILITIES
• Business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
• Principles and processes for providing customer services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• The structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
• Laws, legal codes, court procedures, precedents, government regulations, and agency rules, and the political climate.
• Expertise in area of assignment
• Considering the relative costs and benefits of potential actions to choose the most appropriate one.
• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
• Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Talking to others to convey information effectively.
• Adjusting actions in relation to others’ actions.
• Building Strategic Work Relationships – Developing and using collaborative relationships to facilitate the accomplishment of work goals.
• Aligning Performance for Success – Focusing and guiding others in accomplishing work objectives.
• Strategic Decision Making – Obtaining information and identifying key issues and relationships relevant to achieving a long-range goal or vision; committing to a course of action to accomplish a long-range goal or vision after developing alternatives based on logical assumptions, facts, available resources, constraints, and organizational values.
• Formal Presentation – Presenting ideas effectively to individuals or groups when given time to prepare; delivering presentations suited to the characteristics and needs of the audience.
• Leading through Vision and Values – Keeping the organization’s vision and values at the forefront of associate decision making and action.
• Initiating Action – Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.
REASONABLE ACCOMMODATIONS STATEMENT
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.