AIDS Healthcare Foundation

  • Claim Data Manager

    Job Locations US-CA-Los Angeles
    Req No
    2019-9278
    Category
    Managed Care
    Type
    Regular Full-Time
  • WHO WE ARE

     

    AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

    Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

    If so, AIDS Healthcare Foundation is the place for you!

    Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

    AHF’s core values are:

    • Patient-Centered
    • Value Employees
    • Respect for Diversity
    • Nimble
    • Fight for What’s Right
     
    STILL INTERESTED? Please continue!

    YOUR CONTRIBUTION TO OUR SUCCESS!

    The Manager of Claim/Provider Data Management is integral part of AHF’s Managed Care Division’s leadership team. He or she is responsible for projecting and integrating AHF’s Mission and Core Values of the organization in the provision of provider data management services to internal and external customers of the AHF Managed Care Division.  In addition to overseeing the day-to-day operations of the Provider Data Management Department, he or she is responsible for and directs the configuration of the AHF’s provider management system for the accurate and compliant adjudication of claims from AHF’s Medicare and Medicaid health plans, Ryan White Care Act (RWCA) programs and wellness and prevention (sexually transmitted disease testing) programs.  The Manager of Claim/Provider Data Management is responsible for management of the claims suspense/errors file.

     

    The Manager of Claim/Provider Data Management leads the PDM staff by connecting its daily activities to the mission and core values of the organization to deliver a positive experience to AHF’s contracted and non-participating medical providers and provider groups and AHF’s Department of Medicine and Public Health Division.  He or she develops and implements the organization’s contracts and fee schedules that meet national claims adjudication standards and best practices and standards required by the Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services, Florida Agency for Health Care Administration, and state-issued standards where AHF operates a healthcare center or where AHF will operate a health plan in the future.  He or she is responsible to oversee AHF’s claims pre-processing vendors.

     

    The Manager of Claim/Provider Data Management is responsible for implementing and adhering to AHF’s Management Philosophy of mission driven, fairness, learning, hands-on, accountability and tenacity in the leadership of Claims Department.  He or she contributes to the organization’s success.

     

     
     
    We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability.  The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.

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