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)
Located in Franklin, Tennessee, Williamson Health is one of the South’s most exceptional health care systems with a 203 bed hospital (Williamson Medical Center), over 40 providers at our Williamson Health Medical Group locations, the Bone & Joint Institute and the Monroe Carell Junior Children’s Hospital Vanderbilt at Williamson Medical Center. Williamson Health offers comprehensive in-patient and out-patient services. We have more than 825 providers representing over 70 medical specialties and sub-specialties.
Williamson Health is a system where your talents will be valued and your skillset expanded. We are rooted in our promise to world-class, compassionate care for the residents of Williamson County and surrounding communities, taking exceptional pride in serving our community. We’re committed to empowering our employees to work in innovative ways and reserve time and space for curiosity, laughter and creativity. We value and support the diversity and cultural differences among one another and are committed to upholding an inclusive environment that appreciates the uniqueness of all individuals. Our values are at the heart of everything we do: respect for every individual, the health and total well-being of all people, human compassion and integrity. These shape who we are as an organization and are essential for delivering the highest level of culturally competent care and treatment of every patient, family member, visitor, physician and employee.
Williamson Health is pleased to offer a comprehensive benefits program, that offers you choice and flexibility, so you can take charge of your physical, financial, and emotional well-being.
o Medical, Dental, Vision
o PTO
o Retirement Matching
o Tuition reimbursement
o Discount programs
o FSA (Flexible Spending Accounts)
o Identity Theft Protection
o Legal Aid
Williamson Health is an equal-opportunity employer and a drug-free workplace.
POSITION SUMMARY
Responsible for daily management and oversight of the following departments: Test and Surgery Scheduling, Worker’s Compensation and Utilization Review. Assists the Director of Operations as directed and needed. For purposes of evaluations and attendance, this position reports to the Director of Operations.
POSITION REQUIREMENTS
Formal Education/Training:
Bachelor’s Degree preferred in Business, Healthcare Administration or related field; or equivalent experience.
Workplace Experience:
At least three years of supervisor or higher experience in a medical practice. Billing/collections, front and back-office procedures/policies experience preferred. Demonstrate leadership and good interpersonal skills.
Equipment and Skills Training:
Strong Computer Skills, Communication and Presentation Skills required. Demonstrated ability to self-direct, meet deadlines and support Physician Groups.
Physical Environment:
Physician and Clinical setting/environment.
Physical Effort:
Requires the ability to communicate proficiently; oral and written. Requires prolonged standing and working up to twelve hours if needed. Requires the ability to lift minimal amounts (20-25 lbs).
PERFORMANCE STANDARDS