Director, Claims Revenue Management

Finance New York, New York


Description

We are looking for a Director of Claims Revenue Management to join our Finance team. You will be responsible for leading the team managing claims processing with insurance carriers and patient (“member”) billing. The ideal candidate is an excellent communicator and will be skilled at building relationships across functions and levels throughout the organization and marshaling those resources to get things done.   


What you’ll be doing...

  • You will be responsible for overseeing all of the Finance team aspects of revenue claims management and member billing including the management and development of the team
  • Develop/enhance claims operations strategies and business processes, including KPIs to measure performance
  • Work with carriers, staff, and management to execute the complete, timely, and accurate claims processing and servicing activities in compliance with regulatory agencies and organizational expectations in a manner that strives for operational excellence
  • Identify trends in claims denials, reimbursements and payment discrepancies and implement solutions to facilitate successful claims processing
  • Lead executive reporting on claims processing, denials, patient billing, cash flow, and various special projects
  • Develop and maintain relationships with priority insurance carrier contacts
  • Serve as a point of escalation for claims processing with insurance carriers and assist in removing any barriers or obstacles to high-quality and timely delivery; accountable to influence resolution of Incident tickets impacting claim outcomes timely
  • Oversee the patient billing processes and systems, including communicating with members to answer billings questions
  • Anticipate & identify risks, drive the development and monitor the implementation of comprehensive mitigation strategies; coordinate financial operations responses to regulatory/client external audit requests

 

About you...

  • 10+ years of experience in health care claims processing/accounting/finance operations
  • Bachelors degree required
  • Experience managing a large team
  • Ability to tap into a wealth of knowledge and experience to solve problems and act as an internal consultant
  • Ability to effectively synthesize problems and implement solutions in a fast-paced environment
  • Strong experience in excel and comfortable working with large data sets to analyze and reconcile data
  • Excellent communication ability, able to partner with internal stakeholders, including senior leadership  
  • Ability to present findings to executive leadership in a clear and concise manner

About Progyny:   

Progyny is a leading fertility benefits management company in the US. We are redefining fertility and family building benefits, proving that a comprehensive and inclusive fertility solution can simultaneously benefit employers, patients, and physicians. Our benefits solution empowers patients with education and guidance from a dedicated Patient Care Advocate (PCA), provides access to a premier network of fertility specialists using the latest science and technologies, reduces healthcare costs for the nation’s leading employers, and drives optimal clinical outcomes. We envision a world where anyone who wants to have a child can do so.   

Our mission is to make any member’s dream of parenthood come true through a healthy, timely, and supported fertility and family building journey.   

Come join a company that’s been recognized by Modern Healthcare as one of the Best Places to Work in Healthcare.   

Our perks: 

  • Family friendly benefits: Paid maternity and paternity, fertility benefits (including egg freezing and IVF), emergency childcare program, parent’s group  
  • Health, dental, vision and life insurance options for employees and family  
  • Paid vacation and summer flex time  
  • Company equity  
  • Bonus program  
  • 401K Match  
  • Company social events  
  • Flex days (3 days a week in the office) for positions located at NY office 

In compliance with New York City's Wage Transparency Law, the annual salary range for NYC-based applicants is: $130,000 - $160,000. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity.

Progyny is an Equal Opportunity Employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, 
skills and experiences within our workforce.