Skills & Competencies for Medical Claims Review Manager

Medical Claims Review Manager job profile

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JOB SUMMARY for Medical Claims Review Manager

Oversees the performance, productivity, and quality of the medical claims review staff.

JOB RESPONSIBILITIES for Medical Claims Review Manager

Responsible for hiring, training, and firing medical claims review staff. Evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Typically requires an RN or BSN.

Medical Claims Review Manager SALARY RANGE

BASE 50%
$101,911
TOTAL 50%
$113,533
Job Level
M02
Job Code
HC07000554
Education/Degree
Bachelor's Degree
Reports To
Head of a Unit/Department

Medical Claims Review Manager Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Medical Claims Review Manager skill and competencie below to view definitions.
JOB FAMILY COMPETENCIES CORE COMPETENCIES
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7 general skills or competencies (Job family competencies) for Medical Claims Review Manager

1 Job Family Competencies – Healthcare Industry
Proficiency Level -3
Skill definition-Applying healthcare industry knowledge to manufacture drugs and equipment and offer clinical and other healthcare-related support services.
Level 1 Behaviors
(General Familiarity)
Describes the history and recent developments in the healthcare industry.
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Level 2 Behaviors
(Light Experience)
Locates resources to acquire updates regarding changes in healthcare regulations and requirements.
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Level 3 Behaviors
(Moderate Experience)
Leverages advanced analytics to improve patient-based service outcomes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates healthcare industry changes and proposes objective and strategy improvements.
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Level 5 Behaviors
(Mastery)
Keeps current on issues concerning information privacy to improve customers' trust in sharing personal information.
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2 Job Family Competencies – Healthcare Knowledge
Proficiency Level -2
Skill definition-Utilizing and sharing knowledge of healthcare practices, processes, systems, and procedures to provide high-quality services to patients.
Level 1 Behaviors
(General Familiarity)
Describes the importance and the role of knowledge management within the healthcare industry.
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Level 2 Behaviors
(Light Experience)
Identifies critical competencies and relevant resources to support healthcare advancements.
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Level 3 Behaviors
(Moderate Experience)
Uses a healthcare system to maintain resources for evidence-based research for the organization.
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Level 4 Behaviors
(Extensive Experience)
Manages the creation, coordination, and execution of valuable healthcare programs within the organization.
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Level 5 Behaviors
(Mastery)
Develops and delivers educational programs for employees to improve our healthcare service delivery.
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3 Medical Claims Review Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Medical Claims Review Manager
Proficiency Level - 4
5 Competency for - Medical Claims Review Manager
Proficiency Level - 5

9 soft skills or competencies (core competencies) for Medical Claims Review Manager

1 Core Competencies – Business Performance Management
Proficiency Level -3
Skill definition-Applying business intelligence to monitor and manage overall business performance towards goals.
Level 1 Behaviors
(General Familiarity)
Explains the integral role business performance management plays in an organization.
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Level 2 Behaviors
(Light Experience)
Keeps a clear idea of work responsibilities and the standards of work expected of own business unit.
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Level 3 Behaviors
(Moderate Experience)
Encourages staff to create alternative ideas or solutions after an unsuccessful initial approach.
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Level 4 Behaviors
(Extensive Experience)
Manages the dashboard displaying the business performance via reports, KPIs, and other indicators.
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Level 5 Behaviors
(Mastery)
Measures the efficiency and success of initiatives by monitoring reports, analytics, and KPIs.
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2 Core Competencies – Budgeting
Proficiency Level -2
Skill definition-Applying specific policies, tools and practices to plan and prepare projected revenues, expenses, cash flows, and capital expenditures.
Level 1 Behaviors
(General Familiarity)
Explains the different purposes and uses of our organization's budgets.
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Level 2 Behaviors
(Light Experience)
Gathers financial data to help support management in budgeting analysis and forecasting.
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Level 3 Behaviors
(Moderate Experience)
Prepares and reviews the annual budgeting process to ensure effective and efficient budgeting.
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Level 4 Behaviors
(Extensive Experience)
Monitors budgeting processes to ensure adherence to our organization's financial practices and standards.
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Level 5 Behaviors
(Mastery)
Establishes operating procedures to guide the consistency and repeatability of our budgeting processes.
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3 Medical Claims Review Manager - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Medical Claims Review Manager
Proficiency Level - 4
5 Competency for - Medical Claims Review Manager
Proficiency Level - 5

Summary of Medical Claims Review Manager skills and competencies

There are 0 hard skills for Medical Claims Review Manager..
7 general skills for Medical Claims Review Manager, Healthcare Industry, Healthcare Knowledge, Healthcare Regulatory Environment, etc.
9 soft skills for Medical Claims Review Manager, Business Performance Management, Budgeting, Quality Management, etc.
While the list totals 16 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Medical Claims Review Manager, he or she needs to be skilled in Business Performance Management, be proficient in Budgeting, and be skilled in Quality Management.

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