Claims Reconciliation Manager at Nexus at Geneva

Tampa, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

25 Aug, 26

Salary

0.0

Posted On

27 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Reconciliation, Medical Billing, Medical Coding, Revenue Cycle Management, Financial Analysis, Regulatory Compliance, Vendor Management, Process Optimization, Data Analysis, Healthcare Administration, Payer Relations, HIPAA Compliance, EHR Platforms, Claims Management Systems, Strategic Planning, Leadership

Industry

Description

Job Description THE CLAIMS RECONCILIATION MANAGER AT VEUU PLAYS A CRITICAL ROLE IN ANALYZING, REVIEWING, AND RESOLVING COMPLEX CLAIMS, PARTICULARLY THOSE IN THE DEAD LETTER CLAIM QUEUE. THIS POSITION REQUIRES DEEP EXPERTISE IN CLAIMS PROCESSING, REIMBURSEMENT METHODOLOGIES, AND REGULATORY COMPLIANCE TO ENHANCE CLAIM RECONCILIATION AND ENSURE ACCURATE FINANCIAL OUTCOMES. THE RECONCILIATIONS MANAGER WILL COLLABORATE WITH INTERNAL AND EXTERNAL STAKEHOLDERS TO OPTIMIZE CLAIM RESOLUTION PROCESSES, DRIVE EFFICIENCY, AND PROVIDE STRATEGIC INSIGHTS TO IMPROVE OVERALL CLAIMS MANAGEMENT. JOB SUMMARY * Manage day-to-day reconciliations and reporting, and vendor management (as needed) * Act as the domain expert on claim reconciliation, providing insights and solutions for resolving stalled claims. * Analyze trends within the dead letter claim queue, identifying root causes and implementing corrective actions. * Develop comprehensive claim review strategies to enhance accuracy and minimize revenue loss. * Generate and present claim reconciliation reports, offering data-driven recommendations to leadership. * Work closely with Veuu’s operations, compliance, provider, and payer teams to address claim discrepancies and ensure timely reimbursement. * Provide training and guidance to internal teams on best practices in claims reconciliation and industry regulations. * Recommend process improvements and technology enhancements to streamline claim resolution. * Ensure compliance with payer policies, healthcare regulations, and industry standards. DESIRED CHARACTERISTICS * Strong knowledge of healthcare claims processing, payment reconciliation, and reimbursement methodologies. * Familiarity with CMS guidelines, payer policies, HIPAA, and industry regulations. * Ability to identify payment discrepancies, analyze trends, and implement solutions. * Experience with claims management systems, EHR platforms, and financial reconciliation tools. * Skilled in assessing workflows and recommending improvements to streamline claim resolution. * Ability to interpret and leverage claims and payment data for strategic insights. * Strong ability to work across departments, liaise with payers, and educate teams on best practices. * Self-motivated, results-driven, and able to navigate evolving industry trends and regulations. * Committed to maintaining accuracy, integrity, and compliance in financial transactions. * Open-minded and adaptable approach to problem-solving * Self-motivated and driven to achieve results * Effective multitasking and organizational skills * Enthusiastic and eager to learn and explore new methodologies * Ability to thrive in a fast-paced and dynamic work environment ESSENTIAL RESPONSIBILITIES * Analyze and resolve complex claims and payment discrepancies, particularly within the dead letter claim queue, ensuring accurate financial reconciliation and minimizing revenue leakage. * Leverage AI-driven reconciliation tools to automate claim reviews, detect payment variances, and enhance efficiency, accuracy, and compliance with payer policies. * Partner with internal teams (billing, coding, finance, compliance) and external partners, clients, providers and payers to resolve payment variances, drive process improvements, and ensure seamless claim resolution. * Utilize AI-powered analytics to generate actionable reports on claim trends, payment reconciliation outcomes, and financial variances while ensuring compliance with regulatory and contractual requirements. * Optimized data models for improved accuracy and relevance * Enhanced data infrastructure, processes, and reporting capabilities * Increased productivity and efficiency through data-driven insights * Identification and implementation of improvement strategies based on analysis Qualifications BASIC QUALIFICATIONS * Bachelor’s degree in healthcare administration, finance, business, or a related field (or equivalent experience). * Extensive experience in claims reconciliation, medical billing, coding, or healthcare revenue cycle operations. * Expertise in medical coding (ICD-10, CPT, PCS, HCPCS), reimbursement methodologies, and payer regulations. * Strong analytical, problem-solving, and process optimization skills. * Proficiency in claims management systems, EHR platforms, and reporting tools. * Excellent communication and leadership skills, with the ability to influence cross-functional teams. PREFERRED QUALIFICATIONS * Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or Certified Healthcare Financial Professional (CHFP) * Proficiency in SQL, Power BI, Tableau, or other data visualization tools to analyze claims data and generate actionable insights * Deep knowledge of value-based payments, DRG/APC reimbursement, risk-adjusted payment models, and payer contract negotiations. Additional Information Veuu is an Equal Opportunity and Affirmative Action Employer committed to offering a work environment that supports and inspires equality, professional development, challenging careers, and competitive compensation. It is the policy of Veuu that all personnel processes and employment decisions are merit-based and made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or any other characteristics protected by law. Veuu requires that all successful applicants are legally authorized to work in the United States as a condition of employment. Offers of employment may be subject to the successful completion of a drug screen.

Responsibilities

Manage day-to-day claims reconciliation and resolve complex discrepancies, specifically within the dead letter claim queue, to minimize revenue loss. Collaborate with cross-functional teams and leverage AI-driven tools to optimize resolution processes and ensure regulatory compliance.