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Medical Claims Review Manager jobs in Mississippi

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

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QA Specialists – Billing/ Medical Claims Review
  • Morgan White Group
  • Ridgeland, MS FULL_TIME
  • The QA Specialists - Billing/ Medical Claims Review is part of the Training & Quality Assurance Department and reports to the Quality Assurance Department Manager. The position is a non-exempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

    General Job Duties And Responsibilities

    The QA Specialists - Billing/ Medical Claims Review will ensure that the company's quality standards are observed. This person must be a detail-oriented professional, responsible for the development and implementation of inspection activities, the detection and resolution of problems, and the delivery of satisfactory outcomes. They will effectively communicate results with customers, providers, coworkers, and managers. Preferred candidate has TPA experience and previous BITSY utilization. To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    • Audits internal processes to ensure policies and procedures are followed.
    • Completes reports on the findings from quality assurance reviews.
    • Assists or suggest department standards and P&P to the QA Manager.
    • Provides feedback to the Quality Assurance Manager regarding audit findings within the TPA.
    • Performs other duties as assigned by the QA Manager.

    Experience And Education Requirements

    • High School Diploma or GED required. Associate or bachelor's degree preferred.
    • Minimum of 2 years of Audit or Quality Assurance experience.
    • Minimum of 2 years of Insurance related experience (preferably TPA).
    • Benefit Software and QA knowledge preferred.

    Working Environment

    • Must be able to perform in a very high paced environment and be flexible to multi-task or handle interruptions.
    • Ability to work independently with excellent time management skills.
    • Ability to prioritize and work on multiple projects while completing deadlines in an organized manner.
    • Excellent problem-solving skills along with keen attention to details.
    • Strong written/verbal communication, interpersonal and relationship building skills.
    • Ability to handle stressful situation appropriately.
    • Ability to maintain confidentiality and privacy in every aspect of the job.

    Job Essential Requirements

    The following are job functions that an employee must be capable of performing with or without reasonable accommodation.

    • Must be able to read, write, and speak English; Spanish is a plus.
    • Must be able to work as scheduled.
    • Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met.
    • Must be able to bend, stretch, reach, and sit or stand at a desk during 85 % of the working day.
    • Must be able to lift, stoop, and carry small equipment items and supplies weighing up to 20lbs.

    MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
  • 4 Days Ago
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Medical Review Nurse | Ridgeland, Mississippi
  • Mid South Rehab Services, Inc.
  • Ridgeland, MS FULL_TIME
  • MEDICAL REVIEW NURSERidgeland, MississippiMid South Rehab Services, Inc, Ridgeland, Mississippi, is hiring a full-time Medical Review Nurse to join our Compliance/HIM TEAM. The Medical Review Nurse is...
  • 6 Days Ago
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UTILIZATION REVIEW MANAGER
  • UHS
  • GULFPORT, MS FULL_TIME
  • Responsibilities Gulfport Behavioral Health System (a UHS facility): Gulfport Behavioral Health System, is a 90-bed psychiatric hospital offering child, adolescent, adult and military service behavior...
  • 2 Days Ago
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UTILIZATION REVIEW MANAGER
  • Gulfport Behavioral Health System
  • Gulfport, MS FULL_TIME
  • ResponsibilitiesGulfport Behavioral Health System (a UHS facility):Gulfport Behavioral Health System, is a 90-bed psychiatric hospital offering child, adolescent, adult and military service behavioral...
  • 2 Days Ago
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UTILIZATION REVIEW MANAGER
  • Universal Health Services, Inc.
  • Gulfport, MS FULL_TIME
  • Responsibilities Gulfport Behavioral Health System (a UHS facility): Gulfport Behavioral Health System, is a 90-bed psychiatric hospital offering child, adolescent, adult and military service behavior...
  • Just Posted
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QIDP- Case Manager
  • Case Manager
  • Brookhaven, MS FULL_TIME,PART_TIME
  • POSITION PURPOSE: Responsible for the day-to-day delivery of individual support program services to assigned case load in accordance with Federal, State, and facility codes, regulations, guidelines an...
  • 1 Day Ago
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Medical Claims Review Manager jobs at Popular Companies

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Hospital Medical Leader
  • Petco
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/10/2024 12:00:00 AM
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Hospital Medical Leader
  • Petco
  • Deerfield Beach, FL
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM
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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Noblesville, IN
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/9/2024 12:00:00 AM
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Head of Medical Writing
  • Barrington James
  • Clinical-stage biopharmaceutical company in San Francisco, is seeking a Head of Medical Writing. This leadership role in...
  • 6/8/2024 12:00:00 AM
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Head of Medical Strategy
  • ExecuSearch
  • Atlanta, GA
  • The Head of Medical Strategy provides medical expertise to the rheumatology commercial and medical teams and provides cl...
  • 6/8/2024 12:00:00 AM
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Head of Medical Strategy Rheumatology
  • UCB
  • Atlanta, GA
  • Make your mark for patients The Head of Medical Strategy provides medical expertise to the rheumatology commercial and m...
  • 6/8/2024 12:00:00 AM
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Head of Medical Writing
  • Barrington James
  • San Francisco, CA
  • Head of Medical Writing - Rare disease Biotech We are currently partnered with a growing, west coast based biotech focus...
  • 6/7/2024 12:00:00 AM
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Hospital Medical Leader
  • Petco Animal Supplies, Inc.
  • Plainview, NY
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 6/7/2024 12:00:00 AM
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About Mississippi

Mississippi is bordered to the north by Tennessee, to the east by Alabama, to the south by Louisiana and a narrow coast on the Gulf of Mexico; and to the west, across the Mississippi River, by Louisiana and Arkansas. In addition to its namesake, major rivers in Mississippi include the Big Black River, the Pearl River, the Yazoo River, the Pascagoula River, and the Tombigbee River. Major lakes include Ross Barnett Reservoir, Arkabutla Lake, Sardis Lake, and Grenada Lake with the largest lake being Sardis Lake. Mississippi is entirely composed of lowlands, the highest point being Woodall Mountai...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$87,437 to $111,484

Most Popular Cities in Mississippi for Medical Claims Review Manager Jobs

What does a Medical Claims Review Manager do?

Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiner’s view of a particular bill’s status in a claim record’s related bill screen, or a bill review analyst’s view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019