Who We Are:

Maryknoll Fathers and Brothers – also known as the Catholic Foreign Mission Society of America, Inc. – was founded in 1911 with the support of the Bishops of the United States to be the chief mission outreach of the Catholic Church in the United States. We live and work side-by-side with the poor and marginalized to combat poverty, provide healthcare, build communities and promote human rights in over 20 countries.

Job Description:

Maryknoll Fathers and Brothers is seeking a Medical Claims Manager. The Medical Claims Manager will manage the Health Finance claims function with oversight of end-to-end medical claims processing, adjudication, and payment across multi-state operations, including New York, Chicago, and other territories as needed. The Medical Claims Manager will ensure compliance with federal regulations (e.g. CMS, Medicare, etc.) and applicable state laws. They are responsible for the timely enrollment of Members in all applicable insurance plans to maximize cost containment. In addition, the Medical Claims Manager will oversee EDI claims transactions, ensuring accuracy, timeliness, and compliance with payer, clearinghouse, and regulatory standards including IRS compliance. They will review and audit claim data for accuracy, compliance with HIPAA guidelines, and payer-specific requirements, handling all escalations with superior customer service. The Medical Claims Manager will partner with ma to drive cost containment, regulatory compliance, operational excellence and support and motivate the development and training of staff by making short action plans to meet performance goals and provide feedback on performance.

Qualifications:

• Bachelor’s degree in healthcare administration, information systems, finance, or a related field; or equivalent experience in healthcare claims systems management.
• Minimum of 5 years’ experience in medical billing, claims adjudication, electronic claims processing, EDI workflows, with working knowledge of medical terminology.
• Strong knowledge of federal healthcare regulations, including CMS guidelines, Medicare Parts A/B/C/D, and HIPAA.
• Demonstrated understanding of New York state regulations, including NY DFS requirements, EPIC, and other state sponsored programs.
• Experience managing claims across multiple states, ensuring compliance with varying billing, reimbursement, and reporting rules.
• Experience in skilled nursing facility, assisted living, or long-term care environments desired.
• Advanced expertise with EDI transactions including 837(I/P/D), 835, 270/271, 276/277, and clearinghouse integrations.
• Experience troubleshooting EDI rejections, payer edits, and connectivity issues across multiple state and commercial plans.
• Experience with state-specific EDI requirements and payer enrollment processes.
• Experience preparing for and supporting state and federal audits.
• Ability to interpret and implement regulatory changes impacting claims processing and reimbursement.
• Experience in New York healthcare environment preferred.
• Background in long-term care revenue cycle operations preferred.
• Familiarity with CMS audits, reimbursement, and value-based care models preferred.
• Certifications such as, Certified Professional Coder (CPC), Certified Billing and Coding Specialist (CBCS), Certified Coding Specialist (CCS) preferred.

Benefits: Maryknoll Fathers and Brothers offers a comprehensive benefits package that supports your health and work-life balance. Eligible employees enjoy medical, dental, and vision coverage; a 403(b) retirement savings plan with employer matching; generous paid time off, including vacation, personal time, optional holidays, and sick leave where applicable; flexible spending accounts; life and AD&D insurance; long-term disability insurance; an Employee Assistance Program; access to employee discounts; and opportunities to earn rewards through our employee referral program.

Salary: $100,000 per year

Schedule: Monday – Friday, 8:30am – 4:00pm