Prime Healthcare

Claims Manager

Facility Prime Healthcare Management Inc
Position Type
Full Time


Under the direction of the Director of EPO, Claims Manager is responsible for the day-to-day operations of the EPO Claims functions which include claims review, eligibility update, authorize claims payments, and working with our TPA to ensure all laws and regulations for ERISA are applied. Supervise, hire and trained staff, update workflow and problem solving. Communicate with TPA claims administrator and other in-house staff members. Is current with ERISA and state regulation standards and reports irregularities with billing, claims, documentation, etc. Create reporting for upper management and review reports on physician coding and reports to Manager. Is available for all Benefits staff for coding, regulation and documentation review. Maintains all necessary information needed to comply with insurance billing requirements. Is certified AHIMA, CPC or equivalent.




Education and Work Experience


Required qualifications:

  1. 3-5 years of management experience in Manage Care Claims environment.
  2. Extensive knowledge of professional and hospital claims.
  3. Extensive knowledge of coding, billing.
  4. High School Diploma or GED

Preferred qualifications:

  1. Current CPC (Certified Professional Coder) or equivalent preferred

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law:


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