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Healthcare Claims Manager

A Claims Manager in the healthcare field manages and administrates direction of billing for medical services provided to patients in order to ensure they receive care in the most efficient manner. They work to plan, organize, and direct a medical claims department. A healthcare Claims Manager also coordinates with representatives of outside agencies, and members of the public by providing accurate information in an efficient manner.

Job Duties

Essential functions of a Claims Manager in the healthcare field include, but are not limited to:

  • Monitoring billing activities, performance management, and production standards and quality of results
  • Providing technical assistance to staff in order to initiate billing to all appropriate payer types
  • Analyzes data for bill presentation based on requirements and reviews claims for quality
  • Works to prepare or supervise the preparation of processes and bill presentation to ensure quality and accuracy
  • Stays up to date on State regulations, and implements changes regarding claims and billing requirements

Skills and Education

  • A knowledge of Federal, State, and County codes related to fiscal operations of Health Services
  • A knowledge of basic medical terminology
  • Ability to analyze and interpret problems in data collection, billing, and accounts receivable
  • A bachelor’s degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field
  • Minimum of a few years of experience in healthcare organization, or processing medical claims is generally required
  • Experience in the field above what the minimum requirement is may substitute for some education