Health Claims Adjuducation Senior Manager
Company: Accenture
Location: Los Angeles
Posted on: May 2, 2024
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Job Description:
We are...
We are a global collective of innovators applying the New every day
to improve the way the world works and lives. New doesn't mean
being ahead of the curve; new is pushing forward the curve, riding
the edge where the impossible meets the transformational and making
it reality where it matters. Help us show the world what's possible
as you partner with clients to unlock hidden value and deliver
innovative solutions. Empowered with innovative tools, continuous
learning and a global community of diverse talent and perspectives,
we drive success in a new business architecture that disrupts
conventional practices. Our expertise spans 40+ industries across
120+ countries and impacts millions of lives every day. We turn
ideas into reality.
You are...
As a member of Accenture's healthcare team, you'll be part of a
team of health advisory professionals. From rapid deployments to
entire transformations, you'll deliver leading edge Medicare
strategy and operations capabilities to our clients.
As a Government Health Claims Adjudication Leader , your primary
responsibilities may include:
Medicare Operations & Claims Processing
--- Provide Medicare Operations and Regulatory expertise to support
client partners and operational teams
--- Understand and provide direction to operational teams on
end-to-end Medicare claim processing (e.g. professional/facility
claims, benefit/provider configuration, rate assignments, COB
etc.)
Claims Inventory Management
--- Oversee complete, timely, and accurate claims processing and
servicing activities in compliance with regulatory agencies and
client expectations in a manner that strives for operational
excellence
--- Manage and optimize work production through daily review of
inventory report(s) to assess risk and current performance against
target(s)
--- Understand and develop inventory prioritization strategies
(e.g. TAT, escalations, skillset, capacity planning, etc.) to
actively allocate staff to critical inventories
Claims Quality Management & Process Improvement
--- Identify and evaluate trends in claims denials, reimbursements,
and payment discrepancies and implement targeted solutions/
mitigation strategies (e.g training and action plans) to facilitate
improvements in claims processing and audit findings.
--- Develop pre/post pay audits to monitor an improve staff
productivity, financial accuracy and operational compliance
--- Lead the submission and review of claim audits and present
findings to internal and external audiences; perform additional
tasks/function to facilitate audits as needed.
--- Identify claims process improvement opportunities impacting
system configuration, processing, and training, to improve staff
productivity and operational compliance
Reporting & Analytics
--- Develop and enhance claims reporting metrics including KPIs to
measure inventory, performance, quality, productivity, TAT, and
other critical measures.
--- Lead executive reporting on claims processing, denials,
quality, and responses to regulatory/external audits
--- Support ad-hoc project requests from client partners
Staff Management
--- Manage a global team of claims operations staff for each client
partners, include providing quarterly/yearly performance feedback,
coaching, and training
--- Oversee maintenance of policies and standard operating
procedures
Why should I join the Accenture Health team?
--- Innovate every day. Be at the forefront of designing and
delivering Medicare and other health technology solutions that push
boundaries and create new opportunities for our clients.
--- Lead with the industry's best . Join an industry-recognized
healthcare leader with more than 20,000 global healthcare
professionals collaborating to drive enterprise-wide
transformational projects on a global scale. Accenture has worked
with more than 200 clients to deliver healthcare transformation to
meet the diverse needs of patients and members.
--- Learn and grow continuously. Harness unmatched training and
professional development to help you build and advance your health,
consultative and delivery skills. With learning resources,
interactive classroom courses, real-life client simulations and
ongoing mentoring available when you need it, you'll expand your
thinking beyond the core Workday implementation.
Who will be successful at Accenture?
It's not just what you know or where you've been that propels
success at Accenture: It's who you are , fundamentally, as a
person. We prize diversity in backgrounds and perspectives.
Whatever your unique qualities, a few key traits should apply:
You're passionate about technology and motivated to apply the
latest technology trends. You're proactive and collaborative; a
leader with effective communication skills. You're driven by new
challenges and are motivated to improve. You're a creative problem
solver with the flexibility to navigate uncertainty. You're focused
on the future with a desire to develop inclusive, responsible and
sustainable solutions to complex challenges.
Travel may be required for this role. The amount of travel will
vary from 0 to 100% depending on business need and client
requirements.
Here's what you need:
Bonus points if:
Compensation at Accenture varies depending on a wide array of
factors, which may include but are not limited to the specific
office location, role, skill set, and level of experience. As
required by local law, Accenture provides a reasonable range of
compensation for roles that may be hired in California, Colorado,
New York or Washington as set forth below.
We accept applications on an on-going basis and there is no fixed
deadline to apply.
Information on benefits is here.
Role Location Annual Salary Range
California $131,100 to $336,900
Colorado $131,100 to $291,100
New York $121,400 to $336,900
Washington $139,600 to $309,900
What We Believe
We have an unwavering commitment to diversity with the aim that
every one of our people has a full sense of belonging within our
organization. As a business imperative, every person at Accenture
has the responsibility to create and sustain an inclusive
environment.
Inclusion and diversity are fundamental to our culture and core
values. Our rich diversity makes us more innovative and more
creative, which helps us better serve our clients and our
communities. Read more here
Equal Employment Opportunity Statement
Accenture is an Equal Opportunity Employer. We believe that no one
should be discriminated against because of their differences, such
as age, disability, ethnicity, gender, gender identity and
expression, religion or sexual orientation.
All employment decisions shall be made without regard to age, race,
creed, color, religion, sex, national origin, ancestry, disability
status, veteran status, sexual orientation, gender identity or
expression, genetic information, marital status, citizenship status
or any other basis as protected by federal, state, or local
law.
Accenture is committed to providing veteran employment
opportunities to our service men and women.
For details, view a copy of the Accenture Equal Employment
Opportunity and Affirmative Action Policy Statement .
Requesting An Accommodation
Accenture is committed to providing equal employment opportunities
for persons with disabilities or religious observances, including
reasonable accommodation when needed. If you are hired by Accenture
and require accommodation to perform the essential functions of
your role, you will be asked to participate in our reasonable
accommodation process. Accommodations made to facilitate the
recruiting process are not a guarantee of future or continued
accommodations once hired.
If you would like to be considered for employment opportunities
with Accenture and have accommodation needs for a disability or
religious observance, please call us toll free at 1 (877) 889-9009,
send us an email or speak with your recruiter.
Other Employment Statements
Applicants for employment in the US must have work authorization
that does not now or in the future require sponsorship of a visa
for employment authorization in the United States.
Candidates who are currently employed by a client of Accenture or
an affiliated Accenture business may not be eligible for
consideration.
Job candidates will not be obligated to disclose sealed or expunged
records of conviction or arrest as part of the hiring process.
The Company will not discharge or in any other manner discriminate
against employees or applicants because they have inquired about,
discussed, or disclosed their own pay or the pay of another
employee or applicant. Additionally, employees who have access to
the compensation information of other employees or applicants as a
part of their essential job functions cannot disclose the pay of
other employees or applicants to individuals who do not otherwise
have access to compensation information, unless the disclosure is
(a) in response to a formal complaint or charge, (b) in furtherance
of an investigation, proceeding, hearing, or action, including an
investigation conducted by the employer, or (c) consistent with the
Company's legal duty to furnish information.
Keywords: Accenture, West Covina , Health Claims Adjuducation Senior Manager, Executive , Los Angeles, California
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