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At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.


The Healthcare Claims and Remittance Operation Manager will lead the team which provides support to both the Claims Clearinghouse and the Remit Clearinghouse. The Healthcare Claims and Remittance Operation Manager will work closely with data providers, software development, customer support, and business analyst teams and leaders to monitor file activity and investigate all claims or remit related issues. Issues investigated can include: non-delivery of files, incorrect file formats, claim rejection investigations and provider enrollment verification.


Responsibilities: 

• Plans, staffs, reviews and organizes subordinate supervisor or staff assignments for a department or major group within a department. Provides leadership, coaching, guidance, training and staff development.
• Responsible for staff salary planning, personnel actions, and performance management process.
• Manages departmental financial and operational goals and objectives through subordinate supervisors and staff. May participate with senior management in the development of department budget as well as operational goals and objectives.
• Remains aware of internal company environment, competitive environment, and market trends and developments within functional area. Applies knowledge and provides input to senior management to develop policies and procedures that affect departmental operations and may impact other functional areas.
• Responds to inquiries regarding EDI issues with claims and remits
• Responsible for communicating issues related to claims and remits to internal and external users. Provides root cause analysis, resolution and documentation on problem tickets (using Salesforce)
• Monitor both the Claim Health Monitor and the ERA Monitor (in-house applications) for errors or problems and determine the appropriate method of investigation to use for troubleshooting the problem
• Track open issues and report to customer support, development, and/or clients until resolution is obtained
• Supports team which provides first level customer support and incident management and that are the primary contact for triage and coordination of claim or remit related issues
• Support file transfer processes for both claims and remits as required
• Act as a liaison between development teams and support teams as well as the payers
• Maintains and distributes reports to customers and partners
• Develop tools and/or utilities to help with the troubleshooting process.

REQUIRED:

• BA/BS or equivalent experience
• 5-7 years functional experience in healthcare industry
• Advanced Healthcare industry knowledge 
• Advanced customer service skills 
• Advanced oral and written communication skills 
• Strong attention to detail and routine tasks and checklists is essential 
• General knowledge of health care EDI 27x and 83X transactions


HIGHLY DESIRED:

• Experience working at a healthcare clearinghouse highly desired
• 2-3 years managerial experience 
• Advanced management and leadership skills
• Advanced project management skills


PREFERRED:

• Experience in computer operations 
• General knowledge of TCP/IP networks and experience troubleshooting connectivity issues
• Experience with FTP and secure FTP 
• Expertise in creating and running batch files and basic SQL scripts 
• Experience with SQL Server 2005/2008 or other RDBMS 


Experian is the world’s leading global information services company, unlocking the power of data to create opportunities for consumers, businesses and society. For more than 125 years, we’ve helped consumers and clients prosper, and economies and communities flourish – and we’re not done. Experian has operated at the center of Big Data since before the phrase was coined. Few companies can offer information services on an equivalent scale. Experian has been named to Forbes Magazine’s Top 100 list of the “World’s Most Innovative Companies” for 5 years in a row. We have 16,000 people operating across 37 countries, and every day we’re investing in new technologies, talented people and innovation to help create a better tomorrow.


Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

EOE including Disability/Veterans

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