Medical Claims Review Manager jobs in Mississippi

The QA Specialists - Billing/ Medical Claims Review is part of the Training & Quality Assurance Department and reports to the Quality Assurance Department Manager. The position is a non-exempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

GENERAL JOB DUTIES AND RESPONSIBILITIES:

The QA Specialists - Billing/ Medical Claims Review will ensure that the company's quality standards are observed. This person must be a detail-oriented professional, responsible for the development and implementation of inspection activities, the detection and resolution of problems, and the delivery of satisfactory outcomes. They will effectively communicate results with customers, providers, coworkers, and managers. Preferred candidate has TPA experience and previous BITSY utilization. To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Audits internal processes to ensure policies and procedures are followed.
• Completes reports on the findings from quality assurance reviews.
• Assists or suggest department standards and P&P to the QA Manager.
• Provides feedback to the Quality Assurance Manager regarding audit findings within the TPA.
• Performs other duties as assigned by the QA Manager.

EXPERIENCE AND EDUCATION REQUIREMENTS:

• High School Diploma or GED required. Associate or bachelor's degree preferred.
• Minimum of 2 years of Audit or Quality Assurance experience.
• Minimum of 2 years of Insurance related experience (preferably TPA).
• Benefit Software and QA knowledge preferred.

WORKING ENVIRONMENT:

• Must be able to perform in a very high paced environment and be flexible to multi-task or handle interruptions.
• Ability to work independently with excellent time management skills.
• Ability to prioritize and work on multiple projects while completing deadlines in an organized manner.
• Excellent problem-solving skills along with keen attention to details.
• Strong written/verbal communication, interpersonal and relationship building skills.
• Ability to handle stressful situation appropriately.
• Ability to maintain confidentiality and privacy in every aspect of the job.

JOB ESSENTIAL REQUIREMENTS:

The following are job functions that an employee must be capable of performing with or without reasonable accommodation.

• Must be able to read, write, and speak English; Spanish is a plus.
• Must be able to work as scheduled.
• Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met.
• Must be able to bend, stretch, reach, and sit or stand at a desk during 85 % of the working day.
• Must be able to lift, stoop, and carry small equipment items and supplies weighing up to 20lbs.

MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.