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)
TEMPORARY
JOB SUMMARY
Responsible for sorting mail daily for CMG/CPN group UB-04 and CMS 1500. Make sure all claims are sorted by line of business, multiple dates, PDR, appeal, and retro authorizations. Make sure that the Out of Area claims are identified and forwarded according to regulations.
QUALIFICATIONS
· High School Diploma or Equivalent
· Claims experience, Healthcare experience required
· Requires an ability to communicate well, multitask and stay organized
· Knowledge of Microsoft (Word, Excel, PowerPoint)
· Strong computer and data entry skills
SKILLS
· Must have effective communication, facilitation, interpersonal and professional diplomacy skills.
· Strong attention to detail with ability to manage multiple priorities while meeting deadlines.
· Able to Problem-solve, negotiate and demonstrate independent decision-making.
· Strong communication skills in both oral and written form.
· Positive attitude and takes a team approach to management.
· Maintain strong skills in diplomacy, professionalism and trustworthiness.
· Familiarity with Microsoft applications, which include the ability to learn new computer systems and applications.
· Ability to manage multiple priorities and projects.
· Detail oriented with desire for producing work with 100% accuracy.
· Excellent analytical and problem-solving skills.
Pay: $17/hr – $22.10/hr DOE
As an Equal opportunity employer, DBA Choice Medical Group is committed to a diverse workforce. Employment decisions regarding recruitment and selection will be made without discrimination based on race, color, religion, national origin gender, age sexual orientation, physical or mental disability, genetic information or characteristic, gender identity, and expression, veteran status, or other non-job related characteristics or other prohibited grounds specified in applicable federal, state and local laws. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans’ Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact this post for assistance.
For more information about equal employment opportunity protections, please view the ‘EEO is the Law’ poster.
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Our environment respects individual differences and recognizes each employee as an integral member of our company. Our workforce reflects these values and celebrates the individuals who make up our growing team.
Choice Medical Group provides a work environment free of harassment and prohibited conduct. We promote and support individual differences and diversity of thoughts and opinion.
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