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)
MMRO's Healthcare Review Specialist is responsible for the lifecycle of healthcare claims; including but not limited to, receiving the initial request, reviewing the case for service type and conflict of interest, confirming the appropriate paperwork, creating the report template for the Physician, referring for a medical appointment, calling claimants to get information and/or to give the determination/claim outcome.
Experience that will help you excel in this role: organization, detail oriented, familiarity with medical terminology, scheduling medical appointments, customer service experience and medical office experience.
If you have industry knowledge of healthcare claims, workers comp, short term disability, long term disability or RX claims, that is beneficial.
MMRO seeks new team members who are reliable, punctual, detail oriented, respectful and contribute to a positive workplace culture.
This position works 8am to 4pm EST in our Novi office and rotates on-call weekends for urgent cases. The average weekend work required if on call is up to 5 hours total
Job Type: Full-time
Pay: $42,500.00 - $45,500.00 per year
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Work Location: In person