Associate Director of Claims (Associate Director III)

We strive to deliver the best ? in patient care, research, and education. Experience amazing opportunities and outstanding rewards with the University of Miami, Miller School of Medicine.

This position is eligible for a $500 Employee Referral Bonus consistent with the University policy.

Responsible for supervising the University of Miami Behavioral Health (UMBH) Claims Manager and up to six Claim Processing Staff members whom adjudicate outpatient claims and communicate claim status to the University of Miami Behavioral Health Providers and Inpatient Facilities. The candidate selected with work closely with the MIS Director regarding AHCA rules and regulations for the Medicaid line of business, assuring 80% of the capitation revenue is set aside for Cost of Care. Performs bi-monthly claims payment/check distribution for over 650 providers, 35 Community Mental Health centers and 28 Inpatient Facilities using the IDX Pay Module. Assists the UMBH Claims Manager in performing Back-Out and Replacement claims payments. Makes determinations regarding coordination of benefits (primary versus secondary). Assists the UMBH Claims Manager in utilizing the IDX Pay Module to Void incorrect checks and re-issue correct ones. Over-sees the process of assuring that "Stale Checks" are either cashed by providers or voided in a timely fashion. Conducts internal semi-annual Claim Audits of the UMBH Claims Processing Department to assure that claims are paid in an accurate and timely manner. Develops and implements the UMBH Claims Payment Policies and Procedures. Works closely with the IDX Team and the UMBH Claims Manager to develop capabilities for accepting electronic claims submission and paying claims electronically in the HIPAA approved format, Transaction Standard 835 and 837 in compliance with HIPAA.

Minimum requirements include a Bachelor's Degree in Healthcare, Business or related field plus five years of work-related experience including Mental Health claims, Medicaid claims, Managed Care and MIS systems. English communication skills (both written and verbal) required. Any appropriate combination of relevant education, experience or certifications will be considered.

Discover all this and countless opportunities that reward your talent. The University of Miami, Miller School of Medicine is proud to offer those who lead with us competitive salaries, medical and dental benefits, tuition remission, vacation, university paid holidays and much more. The University of Miami is an Equal Opportunity/Affirmative Action Employer.
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