Medical Claims Review Manager jobs in Washington

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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Medical Claims Review Nurse II
  • Healthcare Management Administrators Inc
  • WA, US, WA FULL_TIME
  • HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. 

    We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

    What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. 

    What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/

    How YOU will make a Difference:  

    The Medical Claims Review Nurse provides monitoring of member utilization and claim patterns using clinical nursing knowledge and coding expertise to oversee the accuracy of claims for medically necessary care provided to our members.  This work promotes the integrity of claim payment to support fiscal responsibility of payments. This nurse also works in conjunction with the Appeals team providing clinical expertise and performs high-level writing skills.  

    What you will do:

    • Analyzes claims against clinical documentation using coding and clinical expertise
    • Clinical  support of the Hospital Bill Review process
    • Retrospective utilization management case review
    • Extrapolates and summarizes medical information for medical director and other external entities
    • Ensures that reviews and appeals are resolved timely to meet regulatory timeframes
    • Generates written correspondence to providers, members, brokers and clients

    Knowledge, Experience, and Key Attributes needed for Success:  

    • Current Baccalaureate prepared (Preferred) 
    • Active RN clinical license
    • Current Certified Professional Coder certificate (preferred)
    • Experience in the application of common coding and billing standards including the American Medical Association CPT (Current Procedural Terminology), the Centers for Medicare and Medicaid Services National Correct Coding Initiative, Optum Coding resource manuals, the UB04 Billing Manual coding guidelines and the National Uniform Billing Committee 
    • 3-5 years of clinical nursing experience
    • Knowledge of Utilization Review processes 
    • Knowledge of the medical plan appeal process (preferred)
    • Strong experience in clinical practice with diverse diagnoses
    • Problem solving and critical thinking skills
    • Excellent verbal and written communication skills
    • Proficiency with Microsoft Office applications (Outlook, Word, DOSS)
    • Ability to be self-motivated and self-directed
    • Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skills 
    • Behavioral health experience (Preferred)

    Compensation
    The base salary range for this position in the greater Seattle area is $85,000 - $108,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. In addition, HMA provides a generous total rewards package for full-time employees that includes: seventeen (IC) days paid time off; eleven paid holidays, one paid personal and one paid volunteer day; company-subsidized medical, dental, vision, and prescription insurance; company-paid disability, life, and AD&D insurances; voluntary life insurances; HSA and FSA pre-tax programs; 401(k)-retirement plan with company match; wellness incentive and reimbursement; remote work and continuing education reimbursements; discount program; parental leave; and a charitable giving match. For more information about HMA, visit www.accesshma.com

    Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.

    How we Support your Work, Life, and Wellness Goals

    We offer a comprehensive total rewards package including: competitive pay; annual incentive; medical, dental, and vision insurance; 401K retirement plan with match; generous PTO and holidays; an onsite gym facility; a gym subsidy; Life, AD&D, Short-Term and Long-Term Disability Insurances; an Employee Assistance Plan; free parking and easy freeway access to I-405 and I-520; a well-stocked kitchen on-site with subsidized snacks and refreshments; year-round wellness activities; the ability to earn a $500 wellness incentive; monthly events; paid volunteer hours and more!

    HMA requires a background screen prior to employment.

    Protected Health Information (PHI) Access Healthcare Management Administrators (HMA) employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA’s standard policies and procedures.

    HMA is an Equal Opportunity Employer

  • 19 Days Ago

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Medical Claims Review Nurse II
  • HMA
  • Bellevue, WA FULL_TIME
  • HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We of...
  • 1 Month Ago

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Field Case Manager
  • Sedgwick Claims Management Services Inc.
  • Seattle, WA 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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Senior Claims Insurance Manager - Medical Professional Liability Claims *Remote
  • Providence Health
  • Washington, WA FULL_TIME
  • Description Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutu...
  • 17 Days Ago

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Senior Claims Insurance Manager - Medical Professional Liability Claims *Remote
  • Providence Health
  • Renton, WA FULL_TIME
  • Description Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutu...
  • 17 Days Ago

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Medical Director - Utilization Review
  • Max Populi, LLC
  • Bellingham, WA FULL_TIME
  • Seeking a Physician Advisor/Medical Director Utilization Review for a Level II Trauma Center and well established hospital serving 255 beds and averaging 15000 inpatient visits yearly. Position locate...
  • 19 Days Ago

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Folsom, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Saratoga Springs, NY
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Orem, UT
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Medical Lead - Oncology, Medical Affairs
  • SEC Life Sciences
  • One of the world's leading pharmaceutical companies is seeking four passionate, forward-thinking individuals for key rol...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Menifee, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/27/2024 12:00:00 AM

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Executive Director, Head of Medical Affairs, Immunology
  • RBW Consulting
  • Philadelphia, PA
  • A major international pharma business is looking to expands its immunology pipeline and requires a dynamic and forward t...
  • 3/25/2024 12:00:00 AM

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Head of Medical Writing
  • Morgan Prestwich - Life Science & Healthcare Executive Search
  • Company Overview Morgan Prestwich is thrilled to be representing our client on an exclusive basis. Our client is a clini...
  • 3/24/2024 12:00:00 AM

Washington (/ˈwɒʃɪŋtən/), officially the State of Washington, is a state in the Pacific Northwest region of the United States. Washington is the northwestern-most state of the contiguous United States. It borders Idaho to the east, bounded mostly by the meridian running north from the confluence of the Snake River and Clearwater River (about 116°57' west), except for the southernmost section where the border follows the Snake River. Oregon is to the south, with the Columbia River forming the western part and the 46th parallel forming the eastern part of the Oregon-Washington border. To the wes...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$104,449 to $133,174

Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiner’s view of a particular bill’s status in a claim record’s related bill screen, or a bill review analyst’s view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019