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Assistant Manager, Claims and Referrals

Yale University - Yale Health New Haven Full-Time
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In 1971, Yale University began a unique and historic experiment in providing health services to its faculty, staff, and students through a multidisciplinary health maintenance organization located on campus. Now, 47 years later, Yale Health has more than 37,000 members including students, staff, faculty, and their families who come from every state in the country and almost every country in the world.

Our providers - physicians, nurse practitioners, nurse midwives, physician assistants, and others - are board certified and committed to a team approach to health care. The fact that Yale Health is not-for-profit means that our patients come first and that we are continually looking at ways to update and improve our services. Yale Health has been continuously accredited by the Joint Commission since 2005 and is the proud recipient of Connecticut’s Malcolm Baldrige National Quality Award for Innovation.

Our state-of-the-art facility at 55 Lock Street, built in 2010, is where our members receive most of their care. It is a 144,000 square-foot medical facility with over 90 exam rooms; a 24/7 Acute Care Department; a 17-bed inpatient facility; a diagnostic imaging suite including MRI, CT scan, x-ray, and ultrasound; and a full-service retail pharmacy. It houses our 150+ providers, including 111 primary and consulting physicians.

We are currently seeking a full-time, Assistant Manager for the Claims and Referrals Departments. Under the direction of the Manager, the position will utilize thorough knowledge of the relationship of referrals to  claims in order to ensure consistent application of benefits for the adjudication of over $138 million in claims annually. The Assistant Manager will foster and actively manage productive and collaborative relationships with Care Management, Utilization Management and Quality Improvement in order to maximize efficiency of healthcare services and procedures; serve as the primary point of contact for vendor payment issues, including research and troubleshooting and provide sound resolution options for complex or non-routine adjudication issues. The Assistant Manager will support vendor contract negotiations, provide suggestions and recommendations for continuous process improvement, hire, train, coach and  monitor staff performance.

Bachelor’s Degree in related field and three years of related experience or an equivalent combination of education and experience.

Demonstrated ability in a Claims or Referrals Department at a supervisory level. Advanced knowledge of claims handling concepts and working ability with ICD-10, CPT-4 and HCPC coding systems. Working knowledge of medical terminology.

Proven leadership and people management skills in order to effectively motivate a service-oriented team. Superior communication and customer service skills and the ability to foster positive, productive working relationships with vendors, members staff and a diverse population.

Proven self-starter with excellent time management skills. Ability to organize and prioritize work. Independent decision-making skills and a solutions-oriented work ethic. Strong reconciliation and workflow design skills. Process and detail-oriented to ensure efficient, cost effective operational activities.

Demonstrated proficiency in the Microsoft Office Suite with advanced proficiency in Excel. Excellent attendance, punctuality and reliability.

Preferred Education, Experience and Skills:

Working knowledge of rules and requirements of ERISA plans; experience with Epic, IDX Managed Care System and Workday Financial System.

Skills required

Data Entry
Microsoft Outlook
Clerical Works
Debits And Credits
Customer Service
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