Bring Your Health Insurance Claims Skills to Healthcare Reform
Manager of Health Insurance Encounter Claims
Attention healthcare claims specialists. The State of Illinois is offering a leadership opportunity in the Division of Medical Programs, Department of Healthcare and Family Services (HFS). Good encounter claims management underpins Medicaid’s transition to managed care. As Manager of Health Insurance Encounter Claims you will join an impactful team of healthcare professionals providing new and creative solutions in the reform of Medicaid and the implementation of the federal Affordable Care Act for over three million Illinois residents.
If you are excited to be on the cutting edge of healthcare reform and want to work in a team of senior policy and decision makers and problem solvers, please send us your resume at the address below. HFS invites applications from qualified individuals excited to participate in a dynamic healthcare transformation initiative. We will respond to qualified applicants immediately and move quickly to facilitate the hiring process. Simply submit your resume.
In this position you will:
- Have a central role contributing to the success of the Department’s many initiatives in managed care.
- Oversee analysis of data on services rendered for rate development, contract compliance, quality monitoring, Medical Loss Ratio (MLR) determination and other functions.
- Direct the encounter claims program, including working with managed care organizations to improve submission and acceptance rates, compliance monitoring and analytic review.
- Ensure availability and use of encounter claims data for critical policy and operational needs.
You must have the following qualifications or experience:
- A bachelor’s degree required and preferably an advanced degree in
- information systems.
- At least two (2) years of healthcare or other similar claims data reporting experience, including, but not limited to,
- data definitions,
- submission, and,
- Background in Health Insurance Portability and Accountability Act (HIPAA) transactions relevant to health insurance claim submissions, with preference for experience specific to encounter claims.
- Requires experience with a
- health insurer or government agency,
- large provider,
- research institution; or
- other knowledge of the healthcare claims system.
- Preferred experience with procedural and diagnosis coding is preferred as well as knowledge of Medicaid policies and procedures.
- Experience managing the business side of IT projects preferred.
- Ability to travel between Springfield and Chicago intermittently.
- Excellent written and verbal communication skills preferred.
Preferred position headquarters is Springfield while Chicago location will be considered.
Illinois residents preferred.
HFS administers the Medicaid and Children’s Health Insurance Program in Illinois, providing a range of healthcare services for adults and children. HFS is redesigning its healthcare delivery system to be more patient-centered, with a focus on improved health outcomes, enhanced patient access, and patient safety. HFS is also realigning payment incentives in support of care coordination models and quality healthcare.
Work Hours & Location:
- Work Shift: 8:30 a.m. - 5 p.m.
- Springfield is the headquarters and preferred location for this position, but Chicago will be considered.
How to Apply:
Compensation shall include an excellent benefit package and salary range commensurate with the State’s Senior Public Service Administrator job title.
Interested applicants should submit their resume either by mail to the address below, by e-mailing the HFS Webmaster
, or by using the Apply button below. Applications sent via e-mail should indicate in the subject line: Application for Position Code XX-XXX
, replacing the Xs with the actual position code(s).
Applications sent by mail should be addressed to
Department of Healthcare and Family Services
Division of Medical Programs
Office Number 3-95
201 South Grand Avenue East – 3rd Floor
Springfield, IL 62763
Scoring of applications will be based on several categories, including education; comparable knowledge and experience; communication skills; supervisory and management experience; and veteran’s preference.
HFS is an equal opportunity employer.