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)
Position: Medical Claims Review Specialist
Location: 10920 Wilshire Blvd, Los Angeles, CA 90024
Duration: 24 week contract
SHIFT: M-F 8-5
Note: This position is 99% remote, with only the orientation and occasional meetings requiring onsite presence.
Job Summary:
We are seeking a skilled Revenue Integrity Analyst / Claims Review Specialist to join our team on a 24-week contract basis. In this role, you will play a pivotal role in optimizing the operational and financial effectiveness of our complex health system. Utilizing your in-depth knowledge of the healthcare revenue cycle, you will analyze complex financial data, identify trends in revenue cycle operations, and provide insightful reports to leadership. Your focus will be on ensuring charge integrity, reconciliation, and compliance with regulatory requirements while supporting clinical and ancillary operational departments in correct coding, billing, and charging principles.
Key Responsibilities:
Required Qualifications: