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)
Summary:
The Registered Nurse will utilize standard criteria to review post-service and prepayment reviews of Outpatient Behavioral Health claims. The nurse will utilize HCPC Codes to ensure claims are being charted for correct processing of Arizona Medicaid requirements.
Responsibilities:
Required Qualifications:
#ASTHIGH
Job Types: Full-time, Contract
Pay: $40.00 - $45.00 per hour
Benefits:
Healthcare setting:
Schedule:
Application Question(s):
Experience:
License/Certification:
Work Location: Remote