Payment Integrity Manager of Claims Administration

• Organize and prioritize workload of the team
• Resources the PI claims administrative team, acts as subject matter expert
• Works with the QA Reviewer to conduct reviews for the PI administrative team.
• Identifies teaching and re-education opportunities for the team and ensures further training is provided and documented.
• Supports clinical department through claims routing and finalization, workflow management and task tracking and quality document tracking.
• Monitor incoming and outgoing electronic claims via our internal processing system
• Research claim questions to properly route inquiries
• Works with other PI department heads to create efficiencies and improved workflows
• Creates training program for new administrative staff and ensures appropriate training is completed for new team members.

• Support a culture that is consistent with 6 Degrees Health values and beliefs
• Works collaboratively with other departments to provide updates on claims status
• Finalizes claim reviews including client and provider report preparation
• Provide detailed reporting on claims volume, billed charges, savings, etc.
• Clearly document claims process and issue resolution
• Work collaboratively with the Claims Team to identify process gaps and improve procedures
• Maintain up to date healthcare industry policies and regulations
• Other responsibilities or projects as assigned
• Work includes the exercise of discretion and independent judgement with disbursement of mail which includes provider appeals and medical claims, disbursement of TPA, Plan and provider emails and discretion and independent judgement with medical claims that need additional research

Minimum Role Requirements

• Associate degree or higher preferred
• 5-7 years of healthcare experience
• Expert user of Microsoft suite including Excel, Word, Visio and PowerPoint
• Excellent verbal and written communication skills

Essential Role Functions

• Must have the ability to read and understand various process flows and procedures
• Strong internal and external communication skills, both verbal and written
• Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary
• Must be able to sit or stand for two hours at a time
• Must be able to operate computers and phones to support position requirements
• Strong Microsoft Office Skills are a must

• Medical, Dental, Vision and Other Outstanding Ancillary Benefits
• Training and Development Opportunities
• Paid Holidays
• 401k Program with 3% employer match
• Remote Work Stipend
• Unlimited Paid Time Off
• Calm App Premium Membership

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa.

The base salary range for this position is between $55,000 and $70,000, plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location.

At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas.

6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

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