Health Insurance Billing Manager

OCES is growing! We are expanding to 11 more towns covering the south shore area, including Quincy, Braintree, Weymouth, etc. APPLY NOW during this exciting time!

OCES supports older adults and individuals with disabilities by providing vital information and coordination of services. By promoting healthy, safe living for our consumers, we hope to allow them to stay active and engaged in their lives and in their own communities for as long as possible.

Our mission: Through the talents of an experienced and diverse workforce, OCES supports the independence and dignity of older adults and individuals with disabilities by providing essential information and services that promote healthy, safe living which positively impacts our community.

We are seeking a Health Insurance Billing Manager responsible for overseeing the end -to-end processing of insurance claims, ensuring accurate, timely, and compliant adjudication. As a leader in our mission- driven non-profit, you will manage a team of claims analysts, resolve complex disputes, and optimize workflows to improve financial performance and reduce denials. This role ensures fiscal compliance with contracts with Senior Care Options and One Care Plans

What you'll do:

• Manage daily claims processing operations, monitoring claims inventory and workload to ensure timely, high-quality, and accurate adjudication.
• Lead, train, and mentor claims staff, providing guidance on complex claims, conducting performance reviews, and fostering an engaged, collaborative team environment.
• Enforce strict adherence to state regulations and internal policies. Prepare for and participate in internal and external audits.
• Identify root causes of payment inaccuracies or discrepancies, perform risk assessments and implement corrective action plans to improve efficiency.
• Collaborate with External Provider Relations contacts and Internal Program Staff to resolve billing disputes and provide a high level of customer support for escalated inquiries.
• Partner with internal and external stakeholders to identify root causes of denials and put processes in place to mitigate in the future.
• Analyze claims data to identify trends, payment efficiencies, and areas of risk. Provide regular reports to senior management on KPIs.
• Research, procure and implement new tools for assisting with billing issues – e.g. AI solution for prior authorizations.
• Effectively communicate and summarize issues for CFO and Senior Team.
• Other duties as assigned

What you'll bring:

• Your passion for helping others and desire to make a difference.
• Bachelor's degree in accounting, business, or related field
• Experience with federal and state contracts
• Master's degree preferred
• Five years of experience minimum
• Excellent written and verbal skills.
• Excellent organizational skills and attention to detail
• Excellent computer skills.
• Proficient with Microsoft Office Suite or related software.
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Work Environment:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift to 25 pounds at times
• Must have personal computer with secure internet access at home

What you'll get:

• The ability to work with an enthusiastic team of like-minded individuals.
• Opportunity to develop professionally in your chosen career.
• Great work/life balance: 35-hour work week with some flexibility; standard M-F work week; hybrid work environment (home, office, and home visits).
• Exceptional benefits: generous paid time off policies; company paid LTD and life insurances; 401K plan.

APPLY TODAY!

OCES is an open, welcoming organization that respects our diversity. We encourage all qualified people to apply!