Education
o High School Diploma, High School Equivalency (HSE), or Completion of a CHS Approved Individualized Education Plan (IEP) Certificate required
o Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Education, Nursing, or a related field preferred
Experience
o Minimum five (5) years of health plan claims processing experience required
o Minimum three (3) years of experience in claims quality assurance, auditing, training, employee development, or related claims operations experience preferred
o Demonstrated experience performing complex claims audits and identifying trends, root causes, and opportunities for corrective action
o Demonstrated experience providing technical guidance, coaching, mentoring, or lead-level support to claims or quality assurance staff
o Experience leading quality improvement initiatives, projects, process changes, or cross-functional operational initiatives preferred
o Experience with commercial, Medicare, Medicaid, and self-funded health plans preferred
o Experience with QNXT or other healthcare claims administration systems preferred
o Experience developing and delivering technical or operational training programs preferred
o Experience supporting regulatory audits, accreditation activities, compliance reviews, or external examinations preferred
Licenses and Certifications
o CPC - Certified Professional Coder preferred
o CCS - Certified Coding Specialist preferred
o CPMA - Certified Professional Medical Auditor preferred
o AHIP certification or other relevant healthcare certifications preferred
o Additional quality assurance, auditing, claims, or healthcare certifications preferred