Manager, Clearinghouse

About the Role

Impact you will make

As a Manager of Clearinghouse, you are responsible for overseeing the successful enrollment and maintenance of electronic payor and trading partner connections in support of the company's Claims Management solutions. The teams provide product and payor expertise and are a key player in supporting the functions of our clearing house operations. They are focused on ensuring the highest level of client satisfaction by quickly and correctly resolving or triaging cases and interacting with clients and payors via verbal and written communication in a professional manner.

What you will do

• Maintenance and enforcement of department policies and procedures including but not limited to:




• Facilitating enrollment of Electronic Data Interchange (EDI) and Trading Partner Agreement (TPA) forms required to submit claims and retrieve reports on behalf of clients
• Managing setup and maintenance of payor connections including assignment of Payor Codes, Receiver IDs, and Payor IDs
• Testing electronic claim submissions in the ANSI 837 format and Eligibility and status inquiries in the ANSI 270, 276 format, once a connection has been established with a payor




• Work with Payors to obtain missing files and ensure industry standards are being followed
• Implement, as necessary, LEAN process improvement techniques to ensure a high level of operational efficiency
• Ensure that department goals are in alignment with internal and external client expectations
• Leverage technical expertise, industry knowledge and communication skills to offer clear and accurate interpretation of industry driven changes to internal and external contacts
• Monitor daily workloads of Payor and Production Support Services team and assist, as necessary, to ensure all objectives are met
• Ensure that an organized and up-to-date internal payor portal containing the various department policies, training materials, payor enrollment forms, companion guides, payor contact info, etc is always available to the applicable analysts and client service teams
• Delegate implementation projects ensuring a balanced load for each team member
• Participate in company's efforts, as applicable, to maintain compliance with CMS standards such as Version 5010 claims standard & ICD-10 coding
• Assist withidentification, testing, resolution and validation process for developed products and system updates to ensure stakeholder needs are met

• Maintain knowledge of payor industry trends and position department enrollment and support activities appropriately to best support our clients
• Participate in new hire training and department continuing education activities
• Develop and manage relationships and communications with external EDI departments
• Drive and manage the Payor connectivity cycle to ensure high level of satisfaction across clients
• Ensure Payor and Production Support Services tickets/issues are addressed and resolved in a timely manner
• Identify, lead, coordinate and provide Project Status to all involved teams
• Ability to motivate and empower team members to resolve issues when resolution is not being reached
• Ability to create reports or define data needed to create reports used to identify potential problems
• Evaluate assimilation of risk assessment data and reporting reports to ensure high quality results
• Ensure that team is kept abreast of all internal happenings
• Ability to effectively communicate with both technical and non-technical personnel
• Maintain and improve methodology used to support file submissions/retrievals
• Successfully complete all mandatory training programs within set timeframes and take appropriate actions to ensure that team meets requirements
• Perform analysis of existing processes and identify gaps and recommend enhancements
• Drive completion of special projects

What you will bring

• 2+ years' experience in healthcare industry
• Comprehensive understanding of hospital revenue cycle
• Ability to communicate with others, including clients, in a clear, understandable and professional manner on the phone, via email and in person; and the demonstrated use of excellent written (i.e. good grammar/spelling) and verbal communication skills
• Demonstrated professional motivation, steadiness and dedication and the ability to develop and maintain successful, long-term, relationships with key industry/client contacts.
• Complex Problem Solving and Critical Thinking skills
• Management of people and resources
• 2+ year's management experience
• Proven knowledge and experience in client support including managing multiple or complex client accounts
• Proficiency in Microsoft Office (Word, Excel, PowerPoint and Outlook).
• Demonstrated organizational, problem solving, time management and analytical skills
• 1+ year of experience in a billing office with consistent communication with the payor or a similar role
• Demonstrated ability to work in a team environment that requires quick turnaround and quality output
• Self-directed approach

What we would like to see

• Bachelor's Degree in a related field
• 2+ year's business process management or Lean methodologies
• Knowledge of HIPAA, EDI and Healthcare X12 transactions
• Supply, Coding or Clinical background
• CRM or Salesforce experience