Job Description
he Role:
TheCustomer Account Directorwill act as theSubject Matter Expert (SME) for claims processingwithin theSeries 3000 claims management system. This leadership role involvesmanaging client relationships, supportingsoftware implementation, guiding thedevelopment team on claims handling, and ensuring thequality and efficiencyof claims processing. You will also overseeclaims-related production measures, facilitateclient training, and work onsystem enhancementsthat improve claims automation and accuracy.
About Hi-Tech Health:
Hi-Tech Health developsturnkey claims administration systemsservingthird-party administrators, insurance carriers, and provider-sponsored health plans. Founded in 1990, our company buildscustomizable, scalablesoftware designed to meet evolving healthcare needs. Our strongclient relationshipsanddedication to innovationdrive our success.
Primary Responsibilities:
Client & Technical Account Management
• Develop and maintainstrong, strategic relationshipswith key client stakeholders.
• Serve as atrusted advisorfor clients, ensuring alignment with business objectives.
• Manage and coordinate the successful delivery ofservices and claims-related initiatives.
• Capture and analyzeclient feedbackto enhance system functionality andidentify product enhancements.
• Serve as aliaison for BPO claims matters, ensuring seamless client communication and resolution of issues.
Claims & System Expertise
• Act as theSME for claims processing, ensuring proper handling within the system.
• Guide thedevelopment teamby advising onclaims programming logic, ensuring that the software processes claims as per client requirements.
• Manage theclaims teamspecifically forproduction and quality measures.
• Provideexpert claims supportby reviewing, investigating, and validatinghospital and physician claims.
• Ensurecompliance with HIPAAand other privacy standards.
Software Implementation & Training
• Work within theimplementation teamtoonboard new clientsand integrate claims processing workflows.
• Train new clients on theSeries 3000system to ensure effective usage.
• Validate the system setup with the client, ensuringaccurate claims adjudication.
• Assist with thefirst billing setup, ensuring clients can successfullyinvoice customers.
Data Management & System Optimization
• Maintain and updateclaims-related data tables, ensuring all elements are current.
• Assist inauto-tasking processes, ensuring properticket distribution and system adjustments.
• Regularly review system performance, identifying and implementingimprovements for efficiency and accuracy.
Cross Department Collaboration
• Work withinternal teams, includingdevelopment, business partners, and leadership, to communicate and meet client requirements.
• Provideregular updateson client initiatives, key metrics, and progress using CRM tools.
• Offerrecommendationsforprocess improvements, automation, and system upgrades.
Qualifications:
• Bachelor’s degree in healthcare administration, Business, IT, or related field (or equivalent experience).
• 5+ years of experiencein healthcare claims processing, adjudication, or technical account management.
• Experience inmanaging claims-related teams, focusing on production and quality assurance.
• Strongtechnical expertise in claims softwareandhealthcare IT systems.
• Proficiency inICD-10, CPT, and HCPCS codesand claims adjudication practices.
• Experience withSQL databases and claims-related system integrationsis a plus.
• Strongproblem-solving, time management, and organizational skills.
• Ability to communicate effectively withtechnical and non-technical audiences.
• Proficiency inMicrosoft Office Suite, CRM tools, and project management software.
• Ability tomulti-task in a fast-paced environment.
Job Type:
• Full-time, in-office role (Plano, TX)
• Monday-Friday, 8-hour shifts
Job Type: Full-time
Pay: $75,000.00 - $95,000.00 per year
Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
Shift:
• 8 hour shift
Education:
• Bachelor's (Required)
Experience:
• Healthcare Claims Processing/Adjudication: 5 years (Required)
• Claims Software and Healthcare IT: 1 year (Required)
• Claim Production/Quality Assurance: 1 year (Required)
Ability to Commute:
• Plano, TX 75093 (Required)
Work Location: In person