Operations Manager

Operations Manager

$23–$26/hour

Monday - Friday from 8:40am-4:40pm

We are a small medical practice seeking an Operations Manager to oversee claims management and day-to-day administrative operations.

1. Claims Management — Approximately 15 Hours/Week

• Oversee the claims process from submission through payment
• Monitor billing activity, denials, aging, and accounts receivable
• Review claims for accuracy and completeness
• Investigate and resolve denied, rejected, or unpaid claims
• Monitor month-to-month billing performance
• Work with providers and staff to obtain documentation needed for billing
• Stay current on Medicaid, Medicare, commercial insurance, and state billing requirements
• Identify recurring billing problems and implement solutions

2. Practice Operations Management

• Complete and follow up on prior authorizations for medications and medical services
• Handle pharmacy calls and medication-related administrative issues
• Communicate with insurance companies regarding eligibility, coverage, and authorization issues
• Assist providers and staff with operational problems as they arise
• Coordinate communication between patients, providers, pharmacies, and insurance companies
• Help improve internal workflows and administrative processes
• Take ownership of problems and follow them through to resolution
• Assist with general office administration and special projects as needed

3. Credentialing

The Operations Coordinator will be responsible for ensuring that every provider and the practice itself are properly credentialed and enrolled with all applicable insurance companies.

Responsibilities include:

• Maintain an up-to-date list of every provider and the insurance plans with which they are credentialed
• Ensure new providers are credentialed with all applicable Medicaid, Medicare, and commercial insurance plans

What We’re Looking For

This is not just a billing position. We are looking for someone who can take responsibility for the administrative health of the practice.

Claims management will account for approximately 15 hours per week. Outside of claims, this person will make sure our providers and practice remain properly credentialed, authorizations are completed, pharmacy and insurance issues are resolved, and administrative problems do not fall through the cracks.

Pay: $23.00 - $26.00 per hour

Work Location: In person