Medical Claims Review Manager jobs in North Dakota

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Medical Review Analyst

The Medical Review Analyst is responsible for the completion and development of medical review reporting requirements to assist in the development of innovations and efficiencies towards the medical review workloads. This position manages all case management activities for effective progressive corrective action.

• Excellent multi-tasking skills
• Prioritization and organization skills
• Strong analytical skills

• Conducts data analysis of reports to determine edits and program effectiveness and acts as the medical review liaison during times of audit activities
• Follows the Progressive Corrective Action (PCA) principles set forth in the Internet Only Manual (IOM) and ensures all statement of work (SOW) requirements are being met
• Reviews and analyzes analytics to determine high risk services or providers
• Takes progressive corrective actions based on the follow-up data analysis to improve provider error rates
• Coordinates activities, updates process, maintains PTS/cases, and conducts reporting for medical review case management
• Develops, maintains, and analyzes statistical reports for very edit to determine effectiveness
• Coordinates meetings with case managers, data analysts, and other medical review staff
• Evaluates data analysis results to determine actions needed
• Submits appropriate System Action Memos (SAMs) and case management activities
• Trains medical review staff on case management activities
• Collaborates with other teams and entitles such as data analysis staff, ZPIC, medical directors, and system support staff
• Assist Provider Outreach and Education (POE) with data analysis and reporting needs
• Responsible for medical review reporting and supports the medical review workload and processes
• Assists in internal and external audit activities
• Contributes positively to a work environment that is flexible, adaptable, and team based

• Other duties as assigned
• Trains new staff
• Reviews Centers for Medicare and Medicaid Services (CMS) correspondence pertaining to medical review and identifies updates needed

• 2 years' college education in Business, Medical Administration, Case Management or related field OR 2 years of Medicare experience
• Advanced PC skills including proficiency in Microsoft Office Suite applications (Word, Excel, Outlook, and PowerPoint)
• Strong verbal and written communication skills
• in-depth knowledge and experience with medical review program requirements, processing systems, and edits and case management activities
• Experience in reporting and analyzing data

• Experience working with medical review and case management activities
• Experience working with system edits and analyzing and interpreting data

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15ounds
• Infrequent stooping

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

Below is the salary range for potential new hires.

Salary Range: $17.20 - $27.25

Other Compensation: Incentive Plan

Lifestyle Benefit: $50/month

This job will be closed 04/24/2024 at 8:00AM CST. No further applications will be considered.