Claims, Audit and Recovery
Manager, Claims Administration
Brea, CA, United States

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and One of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

New Century Health merged with Evolent Health in 2018 and continues to lead transformative change in specialty care management as an Evolent company. Within the Evolent ecosystem of provider-centric solutions for value-based care, our New Century Health team focuses on cost and quality improvement for oncology and cardiology specialty care. With more than 15 years of proven results, New Century Health generates insights and drives cutting edge innovation through its clinical capabilities and deep understanding of health care informatics, physician management and health care technology systems development. Together, Evolent and New Century Health are harnessing the power of our combined organizations to improve the health of the nation. Join the New Century Health team and put your passion to work for transforming the U.S. health care landscape for patients, providers and payers. 

Who You’ll Be Working With:

You will be working closely with the Claims Operations team, Claims IT Team, UM teams, Fulfillment Teams, Network Operations and Contracting teams, and will on occasion work with Executive Management Team.

What You’ll Be Doing:

Responsible for day to day management and oversight of the Claims Department to ensure timely adjudication of claims for health care services, received from contracted and non-contracted providers and to ensure all Federal, State and Client requirements are met timely and efficiently in accordance with regulations and client guidelines. Ensure claims check run activities are completed accurately and timely. Participate in internal and external audits providing subject matter expertise in addition to error trend analysis and remediation. Must have proven track record of strong leadership skills in the execution of management responsibilities. Other  duties as assigned.

 

The Experience You’ll Need (Required):

  • Extensive experience in health insurance claims processing with a minimum of 3 to 5 years management experience.

    In-depth knowledge of medical billing and coding
  • Knowledge of health insurance, HMO and managed care principles 
  • Define and manage staffing needs including recruitment 
  • Critical thinking skills to build efficiencies 
  • Create and manage productivity reports 
  • Create and maintain policy and procedures 
  • Manage and execute projects 
  • Proven ability to meet deadlines, manage competing priorities and go above and beyond to ensure appropriate communications and SLA’s are met.
  • Excellent interpersonal, oral and written communication skills 
  • Strong attention to detail and organization 
  • Able to work independently; strong analytic skills 

    Strong computer skills
  • Proven ability to successfully manage a diverse team while building synergy and establishing succession plans for future growth.
  • Able to effectively forecast overtime needs and the effectiveness of department over time.
  • Manage call volumes and quality for Provider Call Center,
  • In-depth knowledge of Medicare Advantage plans, reimbursement methodologies.

Finishing Touches (Preferred):

  • Associate or Bachelor degree preferred.
  • HMO Claims or managed care environment preferred.

 

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. 

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