Health Claims Adjuducation Senior Manager

We are… 

We are a global collective of innovators applying the New every day to improve the way the world works and lives. New doesn’t mean being ahead of the curve; new is pushing forward the curve, riding the edge where the impossible meets the transformational and making it reality where it matters. Help us show the world what’s possible as you partner with clients to unlock hidden value and deliver innovative solutions. Empowered with innovative tools, continuous learning and a global community of diverse talent and perspectives, we drive success in a new business architecture that disrupts conventional practices. Our expertise spans 40+ industries across 120+ countries and impacts millions of lives every day. We turn ideas into reality.  

You are… 

As a member of Accenture’s healthcare team, you’ll be part of a team of health advisory professionals. From rapid deployments to entire transformations, you’ll deliver leading edge Medicare strategy and operations capabilities to our clients.   

As a Government Health Claims Adjudication Leader, your primary responsibilities may include: 

Medicare Operations & Claims Processing

·       Provide Medicare Operations and Regulatory expertise to support client partners and operational teams

·       Understand and provide direction to operational teams on end-to-end Medicare claim processing (e.g. professional/facility claims, benefit/provider configuration, rate assignments, COB etc.)

Claims Inventory Management

·       Oversee complete, timely, and accurate claims processing and servicing activities in compliance with regulatory agencies and client expectations in a manner that strives for operational excellence

·       Manage and optimize work production through daily review of inventory report(s) to assess risk and current performance against target(s)

·       Understand and develop inventory prioritization strategies (e.g. TAT, escalations, skillset, capacity planning, etc.) to actively allocate staff to critical inventories

 Claims Quality Management & Process Improvement

·       Identify and evaluate trends in claims denials, reimbursements, and payment discrepancies and implement targeted solutions/ mitigation strategies (e.g training and action plans) to facilitate improvements in claims processing and audit findings.

·       Develop pre/post pay audits to monitor an improve staff productivity, financial accuracy and operational compliance

·       Lead the submission and review of claim audits and present findings to internal and external audiences; perform additional tasks/function to facilitate audits as needed.

·       Identify claims process improvement opportunities impacting system configuration, processing, and training, to improve staff productivity and operational compliance

Reporting & Analytics

·       Develop and enhance claims reporting metrics including KPIs to measure inventory, performance, quality, productivity, TAT, and other critical measures.

·       Lead executive reporting on claims processing, denials, quality, and responses to regulatory/external audits

·       Support ad-hoc project requests from client partners

               Staff Management

·       Manage a global team of claims operations staff for each client partners, include providing quarterly/yearly performance feedback, coaching, and training

·       Oversee maintenance of policies and standard operating procedures

Why should I join the Accenture Health team? 

·       Innovate every day. Be at the forefront of designing and delivering Medicare and other health technology solutions that push boundaries and create new opportunities for our clients. 

·       Lead with the industry’s best. Join an industry-recognized healthcare leader with more than 20,000 global healthcare professionals collaborating to drive enterprise-wide transformational projects on a global scale. Accenture has worked with more than 200 clients to deliver healthcare transformation to meet the diverse needs of patients and members.   

·       Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health, consultative and delivery skills. With learning resources, interactive classroom courses, real-life client simulations and ongoing mentoring available when you need it, you’ll expand your thinking beyond the core Workday implementation. 

Who will be successful at Accenture? 

It’s not just what you know or where you’ve been that propels success at Accenture: It’s who you are, fundamentally, as a person. We prize diversity in backgrounds and perspectives. Whatever your unique qualities, a few key traits should apply: You’re passionate about technology and motivated to apply the latest technology trends. You’re proactive and collaborative; a leader with effective communication skills. You’re driven by new challenges and are motivated to improve. You’re a creative problem solver with the flexibility to navigate uncertainty. You’re focused on the future with a desire to develop inclusive, responsible and sustainable solutions to complex challenges.  

Travel may be required for this role.  The amount of travel will vary from 0 to 100% depending on business need and client requirements.