Manager, Claims – Contessa Health

Contessa offers a unique opportunity for individuals interested in being part of an organization that is leading the country in redefining the way care is provided to patients. Contessa’s Home Recovery Care model brings all the essential elements of inpatient care to the comfort and convenience of a patient’s home. The model enables provider organizations and health plans to deliver high-quality, safe and affordable care to patients with non-life-threatening conditions. At Contessa, you will have the opportunity to make a direct impact on the lives of patients and be at the forefront of shaping a pioneering space in the health care industry. 

Job Summary

The Manager, Claims has direct oversight of the Claims department which includes the processing and payment of day-to-day claims transactions for all network providers according to Contessa contracts and insurance claim processing guidelines. This role is responsible for establishing initial connectivity to provider partners and influences system enhancements for Contessa’s proprietary claims platform by targeting opportunities through analyses of claims process data and reporting, then detailing business requirements to the Product team. The Manager, Claims will compile feedback on processes from the claims team to continually optimize efficiency and accuracy of claims operations. This role defines the parameters for the creation of any reporting necessary to effectively monitor and improve claims operations.

The Manager, Claims ensures duties are completed accurately, timely, and efficiently while acting as a team player for optimum office flow and excellent network provider service. 

Primary Responsibilities

• Oversee Claims department day to day operations, identify key performance metrics, and create reporting to facilitate ongoing monitoring of those metrics
• Identify Claim department workflow bottlenecks/constraints and create solutions to resolve and maximize efficiency
• Work with Product and Software Development team to implement solutions and enhance Contessa’s proprietary claims processing system 
• Provide expertise to support the review and research for claim inquiries
• Analyze and identify trends and provide reports as necessary
• Consistently meet established productivity, schedule adherence and quality standards
• Coordinate revenue cycle reporting and deliverables
• Ensure claims are accurately adjudicated in accordance with health plan guidelines, company and client standards, and company procedures
• Maintain completed and updated set of resource materials necessary for processing claims
• Provide guidance on system configuration processes for payers and providers
• Communicate with provider partner contacts on all aspects of the revenue cycle
• Attend all company-mandated training and remain current with knowledge in the claims field

• Experience: 8-10 years of medical claims experience, including contract analysis, billing, clearinghouse connectivity, and loading/configuring new providers in claims adjudication system(s)
• Education: College degree preferred 
• Teamwork-Centered: Innovative, highly flexible, and willing to “roll-up-your-sleeves” to do what it takes in a team environment to accomplish our mission. 
• Communication Skills: Able to communicate efficiently and effectively with people in all levels of business. Excellent written and verbal communication skills with the ability to prepare and present materials and to execute and maintain written reports and records. Exhibits exceptional interpersonal skills and proper judgment when dealing with key partners, staff, and clients.
• Project Management, Strategic Thinking, and Analytical: Able to manage multiple projects and priorities, quickly and creatively, solve problems, and develop effective communications and strategies. Strong ability to process disparate information and data effectively into analysis for decision making purposes. 
• Customer Service Skills: Every decision needs to be made with the customer in mind 
• Must be proficient with Microsoft Office, Microsoft Excel in particular
• Strong research and analytical skills
• Ability to work independently and escalate for assistance as needed
• Experience with standardized EDI x12 837 and 835 formatting, configuration, and/or editing is a plus

Our team members are our greatest asset. That’s why you’ll find that Contessa has built a culture around trust, open communication, and a unified desire to change the way healthcare is being delivered. It’s important to us that you like your job, are motivated by the work you do every day and feel supported by leadership. Contessa offers a generous compensation and benefits package, a strong belief in a healthy work-life balance and great opportunities for career growth.