Project Manager Healthcare Claims (Remote)

We are seeking a highly skilled and experienced Healthcare Claims Project Manager to join our esteemed consulting team in a remote capacity. This pivotal position reports directly to the Program Director, providing a unique opportunity to spearhead significant projects and enhance your professional journey within the healthcare sector.

Key Responsibilities

• Lead and oversee healthcare projects focused on claims processing and payment, ensuring the achievement of successful outcomes.
• Analyze Statements of Work (SOWs) and Requests for Proposals (RFPs) to identify opportunities, conduct thorough research, and formulate comprehensive implementation strategies.
• Supervise project execution and collaborate with subcontractors to uphold client requirements and compliance.
• Employ Excel to manipulate and analyze medical claims data, utilizing advanced techniques to uncover trends and insights.
• Effectively manage project budgets, ensuring optimal resource utilization while comprehending the overall budget creation process.
• Develop and execute strategies aimed at enhancing the efficiency and accuracy of claims processing.
• Engage closely with clients to ascertain their needs and provide tailored solutions.
• Examine claims data to detect trends, issues, gaps, and critical focus areas pertinent to the project.
• Ensure adherence to all relevant healthcare regulations and standards.
• Collaborate with IT departments to oversee file transfers and maintain data integrity.
• Offer training and support to clients and team members regarding claims processing and payment systems.
• Prepare in-depth reports and presentations for clients and stakeholders.
• Monitor project progress diligently and make necessary adjustments to meet deadlines and project objectives.

Required Skills

• Minimum of 5 years’ experience in healthcare claims processing and payment.
• At least 3 years’ experience leading and managing programs involving a team of 3 or more full-time resources, with a total budget of $4M or more.
• Familiarity with various claims payment systems that enable end-to-end claims processing.
• In-depth understanding of claims processing files and file transfer processes.
• Proven project management capabilities, with a successful track record in managing complex healthcare projects.
• Strong analytical and independent problem-solving skills, particularly in a remote working environment.
• Exceptional communication and interpersonal skills, thriving in a collaborative atmosphere.
• Proficiency in relevant software tools (e.g., Excel, MS Planner, MS Project, EncoderPro, Codify, SharePoint, Salesforce).
• Ability to work independently as well as collaboratively within a team.

Qualifications

• Bachelor’s degree in a relevant field such as Healthcare Management or Business Administration.
• Preferred experience in a healthcare consulting context with a focus on government programs and familiarity with Medicaid, TRICARE, and group health plans.
• Management or leadership experience with direct or indirect reports involved in claims or record review is advantageous.
• Experience with state or federal contracts and engagement with government stakeholders is a plus.
• Project management certification (e.g., PMP, PRINCE2) is desirable.

Career Growth Opportunities

This role offers substantial opportunities for professional development and career progression within a leading healthcare consulting firm, allowing you to expand your skills and meet new challenges in a thriving work environment.

Company Culture And Values

Our organization fosters a collaborative, innovative, and excellence-driven culture. We are committed to making a meaningful impact in healthcare, and we seek professionals who share our dedication to advancing the industry.

Employment Type: Full-Time