Medical Claims Review Manager jobs in Anaheim, CA

Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Claims Manager
  • Ultimate
  • Diamond, CA FULL_TIME
  • Job Description

    Responsibilities/Duties:

    • Provide an environment that allows staff members to flourish in their work duties. Quality levels of 99% maintained throughout the department.
    • Continuous training of staff on responsibilities as well as on all enhancements and updates to claims regulations and company policies.
    • Develop procedure changes to improve results. Corrective action plans developed and implemented to remediate any shortcomings in goal achievement.
    • Maintain quality goals and production levels within the Department to ensure quality and production goals associated with each work area are consistently met by staff during their regularly scheduled work hours.
    • Create, maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet the requirements of Call the Car.
    • Track and trend the metrics associated with the claims adjudication.
    • Prepare and present written and verbal reports.
    • Research complex problem areas within the department or within the systems used by department and identify the root cause of these issues and recommend corrective actions.
    • Supervise staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
    • Perform special projects and ad-hoc reporting as necessary. Projects will be complete, and reports will be generated within the specific time frame agreed upon at the time of assignment.
    • Working with internal departments to resolve issues preventing claims processing or enhancing processing capabilities.
    • Assist in testing, changing, analyzing and reporting of specific enhancements
    • Any other duties as assigned by management.

    Minimum Qualifications:

    • High School diploma or GED Required.
    • 4 years processing claims/invoices experience preferred.
    • At least 3-5 years of experience as claims examiner working with medical facility claims
    • At least 2-3 years of lead/supervisory experience.
    • Experienced in working with Provider Dispute Resolution (PDR's).
    • Must have extensive experience in handling claims appeals with experience in communicating with external providers.
    • Sound understanding of health care code sets including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), ICD-10 and revenue codes required.
    • Familiarity with Diagnosis Related Group (DRG) pricing.
    • Position requires the ability to multitask in a high production environment.
    • Familiarity in working with and interpreting Provider contracts
    • Ability to draw conclusions from data analysis and to formulate corrective action plans when necessary.
    • Proficient in using Microsoft Word and Excel.
    • Must have strong coaching and mentoring skills and have the ability to build effective teams.
    • Must have excellent written and verbal communication skills with ability to work effectively with diverse team members.
    • Ability to research complex claims problems and to create clear and concise procedures for the handling of complex claims.
    • Must pass a Criminal Background Screening.
    • Must pass government exclusion list at time of hire and monthly thereafter.
    • Familiarity with various basic PC usage.
    • Able to type at least 40 wpm.
    • Availability to work any day and any shift; holidays and weekends.

    All qualified applicants will receive consideration for employment without regard to race
    To apply please email your resume to tmeans@ultimatestaffing.com

  • 1 Day Ago

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Claims Manager
  • Ultimate
  • Brea, CA FULL_TIME
  • Job Description Excellent opportunity to work for a growing reputable company located in Diamond Bar, CA. We are seeking candidates that are looking for stability, growth and a great culture. This pos...
  • 1 Day Ago

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Claims Examiner - Remote Position
  • Primary Care Associates of California, Medical Group
  • Cypress, CA FULL_TIME
  • The Claims Examiner is responsible for processing medical claims in an efficient, cost-effective, and timely manner.Daily Responsibilities: Responsible for determining financial responsibility between...
  • 5 Days Ago

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Claims Examiner - Workers Compensation (Hybrid Opportunity!)
  • Sedgwick Claims Management Services Inc.
  • Brea, CA FULL_TIME
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
  • 5 Days Ago

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CA - Field Representative
  • Hancock Claims Consultants
  • Anaheim, CA FULL_TIME
  • With a 20-year history supporting property insurers, Hancock Claims Consultants provides a nationwide network of inspectors, contractors, and engineers who help adjusters quickly process claims. All 5...
  • 24 Days Ago

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Graduate Medical Education Manager (GME)
  • West Anaheim Medical Center
  • Anaheim, CA FULL_TIME
  • Graduate Medical Education Manager (GME) Facility West Anaheim Medical Center Location US-CA-Anaheim ID 2024-156940 Category Manager Position Type Full Time Shift Days Job Type Exempt Overview Join an...
  • 1 Day Ago

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0 Medical Claims Review Manager jobs found in Anaheim, CA area

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Nurse Manager Surgery
  • Clinical Management Consultants
  • Pasadena, CA
  • A very highly accredited acute care hospital in Southern California is looking to bring on a new Nurse Manager Surgery t...
  • 3/26/2024 12:00:00 AM

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Licensed Vocational Nurse (LVN) Sub-Acute PEDS - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Nights (Tustin)
  • Alta Hospitals
  • Anaheim, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/26/2024 12:00:00 AM

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Licensed Vocational Nurse (LVN) Med Surg - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Evening/Mid (Tustin)
  • Alta Hospitals
  • Anaheim, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/26/2024 12:00:00 AM

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Licensed Vocational Nurse (LVN) Sub-Acute PEDS - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Nights (Tustin)
  • Alta Hospitals
  • Westminster, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/26/2024 12:00:00 AM

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Licensed Vocational Nurse (LVN) Med Surg - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Evening/Mid (Tustin)
  • Alta Hospitals
  • Westminster, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/26/2024 12:00:00 AM

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Licensed Vocational Nurse (LVN) Med Surg - Loan Forgiveness & $7,000 Sign-on Bonus - Full Time, Evening/Mid (Tustin)
  • Alta Hospitals
  • La Habra, CA
  • The Licensed Vocational Nurse performs a wide variety of patient care activities under the direction of registered nursi...
  • 3/26/2024 12:00:00 AM

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Front/Back Office Assistant
  • Candy Medical Management
  • Hermosa Beach, CA
  • Job Description Job Description Pier Medical Aesthetics/ Candy Medical Mgmt is hiring a part-time to grow to full-time f...
  • 3/25/2024 12:00:00 AM

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Sr Accountant Financial Reporting
  • X Engineering & Consulting Inc
  • Santa Ana, CA
  • Job Description Job Description Your duties shall be, but not be limited to: · Preparing financial reports · Performing ...
  • 3/25/2024 12:00:00 AM

Anaheim (/ˈænəhaɪm/) is a city in Orange County, California, part of the Los Angeles metropolitan area. As of the 2010 United States Census, the city had a population of 336,265, making it the most populous city in Orange County and the 10th-most populous city in California. Anaheim is the second-largest city in Orange County in terms of land area, and is known for being the home of the Disneyland Resort, the Anaheim Convention Center, and two major sports teams: the Anaheim Ducks ice hockey club and the Los Angeles Angels baseball team. Anaheim was founded by fifty German families in 1857 and...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$108,791 to $138,710
Anaheim, California area prices
were up 3.2% from a year ago

Medical Claims Review Manager in Paramus, NJ
Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.
February 01, 2020
Medical Claims Review Manager in Nashua, NH
By truly combining claims and bill review, the two systems are kept in sync utilizing the scheduled jobs of the aforementioned standard model; however, for real-time data updates, claims examiners are granted access to the entire live bill review system.
January 13, 2020
Medical Claims Review Manager in Davenport, IA
Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.
January 03, 2020