Medical Claims Review Manager jobs in Fort Smith, AR

SCOPE OF POSITION:
Responsible for managing specific areas of AFMC’s review services in accordance with contract deliverables. Responsible for the supervision assigned staff. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence Accountability, Respect and Teamwork.

ESSENTIAL JOB FUNCTIONS:

KNOWLEDGE, SKILLS AND ABILITIES:

• Intermediate skill level with MS Office (Word, Excel, Outlook, and PowerPoint).
• Type 40 wpm.
• Exceptional skills in business English and spelling required.
• Ability to maintain confidentiality.
• Coaching skills.
• Strong oral and written communication skills.
• Creativity.
• Customer service.
• Ability to delegate as required.
• Ability to meet deadlines.
• Attention to detail.
• Flexibility.
• Knowledge of ICD 9/ICD 10 Coding.
• Knowledge of HIT/EHR.
• Medical terminology.
• Ability to work collaboratively and independently to achieve stated goals.
• Initiative.
• Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients and the public.
• Leadership skills.
• Ability to multitask.
• Ability to prioritize.
• Strong organizational skills.
• Problem solving skills.
• Professionalism.
• Project management skills.
• Ability to read, interpret and apply laws, rules and regulations.
• Knowledge of quality improvement processes and techniques.
• Valid driver’s license.
• Ability to travel, including overnight travel.
• Time management skills.

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations.

EDUCATION:
Required: Associate or Bachelor’s degree in Health Information or Nursing ( ), licensed as a Registered Nurse in the state of Arkansas, without restrictions.
Desirable: Master’s degree in nursing, health services administration, public health, business or related field

EXPERIENCE:
Required: Five (5) years clinical nursing experience, Three (3) years leadership experience.
Desirable: Clinical experience in specialty area, experience in quality assurance, utilization review, coding, Medicare or Medicaid, QIO experience preferred.

INTERNET REQUIREMENTS:
Reliable, high-speed wireless internet service (Wi-Fi)
An upload speed of at least 2Mbps is required to support softphone functionality.