Medical Claims Review Manager jobs in Arkansas
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)
Recently Added Medical Claims Review Manager jobs
- AFMC
-
Fort Smith, AR
FULL_TIME
-
Job Description:
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:
- Select, direct, coach and evaluate the assigned review staff. Develop standards of staff performance and set annual performance objectives. Ensure the quality and accuracy of work performed and that staff meet performance goals within designated time frame.
- Supervise assigned review program/area/functions. Plan, schedule, direct and monitor review activities to comply with contract deliverables.
- Develop and maintain manuals of policies, procedures, objectives and quality assurance for assigned review area.
- Ensure review activities are documented through data system or manually and adequate controls are in place to assure validity of entry and results.
- Function as a resource for clinical and non-clinical staff by providing oversight and follow-up for clinical related questions or issues.
- Develop proposals and facilitate implementation of projects, procedures, and controls for current and anticipated contracts in cooperation with the Director, Clinical Review and Senior Director, Clinical Review.
- Communicate effectively with internal and external clients. Upon request, verbally informs patients, facility personnel, the attending physician and other ordering providers, and health professionals of specific utilization management requirements and procedures
- Serve as liaison between departments and vendors to provide information, project updates or in the resolution of administrative problems and inquiries.
- Assume review activity during clinical review specialist absence or when assistance is needed. Work concurrently with clinical review specialist for evaluation and training purposes.
- All clinical review managers will participate in the Quality Management Committee. Five percent of your time is allocated to the Quality Management Committee.
- Analyze and control expenditures of department to conform to budgetary requirements.
- Generate reports of projects activities as assigned or directed.
- Maintain knowledge of specific projects including: contract, contract deliverables, policies and procedures, etc.
- Assist in preparation, production, and delivery of educational activities for staff.
- Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
- Meet regularly with assigned staff to communicate pertinent information, needs and requests to other team members as appropriate.
- Train assigned staff on job specific regulations and contract requirements.
- Ensure AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
- Additional duties as assigned.
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. - 19 Days Ago
- Safety Claims Coordinator
-
Little Rock, AR
FULL_TIME
- At CalArk, we respect what you have to offer. Our industry-leading wages and benefits ensure you always feel appreciated for what you individually bring to our team. Your talent has a home with us.
- 4 Days Ago
- Ideal Staffing Inc.
-
Little Rock, AR
FULL_TIME
- Great Arkansas Certified Private Bill Review company is seeking an experienced certified professional to perform the job of Medical Bill Auditor. To review medical bills received by Arkansas Workers’ ...
- 15 Days Ago
- EngageMED Inc
-
North Little Rock, AR
FULL_TIME
- DescriptionJOB SUMMARY:A nonexempt position responsible for the proper and timely processing of claims and payments to providers. Duties/Responsibilities:Follows up on denied or pended medical claims ...
- 25 Days Ago
- Max Populi, LLC
-
Little Rock, AR
FULL_TIME
- 100% Remote opportunity to conduct utilization management - chart reviews for a brand name specialty benefits company. We are seeking several physicians with a board certification in Medical Oncology/...
- 15 Days Ago
- Copper Claims Services, Inc.
-
Little Rock, AR
FULL_TIME
- 1099 Property Claims Adjuster Copper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA. Copper Claims Services excels in providing custom claims solutions fo...
- 1 Month Ago
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- Nuvalent Inc.
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- Aerovate Therapeutics Inc.
-
Waltham, MA
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- Petco Animal Supplies Inc
-
Montclair, NJ
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- HeartFlow, Inc
-
New York, NY
- HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
- 4/21/2024 12:00:00 AM
- HeartFlow
-
New York, NY
- HeartFlow, Inc. is a medical technology company advancing the diagnosis and management of coronary artery disease, the #...
- 4/21/2024 12:00:00 AM
- Aerovate Therapeutics, Inc.
-
Waltham, MA
- Aerovate (AVTE) is a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the ...
- 4/20/2024 12:00:00 AM
- Baptist Memorial
-
Memphis, TN
- Summary Provides personal care assistance to patients under the direction of licensed personnel and /or Administrator. P...
- 4/20/2024 12:00:00 AM