Medical Claims Review Manager jobs in Wisconsin
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
Senior Medical Bill Review Auditor
- Rising Medical Solutions
-
Milwaukee, WI
FULL_TIME
-
Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations. At RISING, we're committed to:
- Continuous technological improvement
- Entrepreneurial attitude
- Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what's important, and keeping a sense of humor
- Responding quickly to client needs
- Being the best, not the biggest
The Senior Medical Bill Auditor will maximize savings for clients by accurately analyzing and processing medical bills according to state laws and fee schedules, industry standards, appropriate network contracts, client specific instructions, and company policies and procedures.
Core Responsibilities include:- Adhere to all company Core Values daily
- Analyze small to mid-size dollar threshold medical bills for payment recommendations based on state worker's compensation law, fee schedules, usual and customary rates (UCR), current PPO contracts, coding and bundling guidelines, client instructions, claim history, and company policies and procedures
- Achieve production goals to maintain turn-around-time per client contracts
- Achieve payment accuracy goals
- Generate accurate and easy-to-understand Explanation of Review (EOR) statements and correspondence letters
- Participate in ongoing training to be in compliance with process changes and to enhance job skills and knowledge
- Participate in team meetings to communicate and learn knowledge and information related to job function, company, and industry
- Follow HIPAA and ARRA laws and regulations
Operations Manager
Requirements- High School Diploma required; some College preferred
- State Certification, Certification in a related field (i.e., CPC) a plus
- 4 years of medical billing (or related) experience
- Previous worker's compensation industry experience a plus
- Prior experience with Microsoft Windows and Office applications (Word, Excel, Outlook, etc.)
- Strong data entry speed and accuracy required (Minimum of 10,000 keystrokes per hour, data entry accuracy of at least 93%)
- Ability to read, analyze and interpret technical procedures, state laws, coding/bundling guidelines and fee schedules
- Ability to communicate clearly and effectively, in both written and verbal contexts, to peers, clients and providers
- A desire to continue to learn and improve both self and the organization
- Mathematical aptitude (calculating PPO discounts, savings shifts, percentage fees, negotiations, etc.)
- Practical problem-solving skills
- Ability to organize resources and establish priorities
- Ability to facilitate a cooperative work environment
- Meticulous attention to detail
- Patience to perform routine functions daily
- Excellent time management skills
- Remaining in a seated position
- Entering text or data into a computer
- Visual Acuity
- Talking
- Hearing
- Repetitive arm, hand, finger motion
- Work is normally performed in a typical interior/office work environment.
- Health insurance (4 different plans to choose from)
- Dental
- Vision
- Paid time off (PTO) or Flexible Time Off (FTO)
- 401(k)
- Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
- Voluntary Life Insurance and Short-Term Disability Insurance
- Flexible Spending Accounts (FSA)
- Employee Assistance Program (EAP)
- Rise Well Wellness Program
- Professional Development Reimbursement Program (PDRP)
- You will be part of our new Elevate program designed to recognize and reward employees for their hard work
- 9 Days Ago
Medical Billing & Claims Specialist
- TEKsystems
-
Spencer, WI
FULL_TIME
- Description A Medical Billing & Claims Specialist is responsible for working and managing Accounts Receivable for our Clinic and Surgery Center and providing excellent customer service to our patients...
- 4 Days Ago
Medical Insurance Claims Specialist
- Robert Half
-
Greendale, WI
PER_DIEM
- Robert Half is seeking a detail-oriented and highly organized individual to join our client's team as a Medical Insurance Claims Follow Up Specialist. In this role, you will be responsible for ensurin...
- 26 Days Ago
Medical Oncology Remote Chart Review Physicians
- Max Populi, LLC
-
Milwaukee, WI
FULL_TIME
- 100% Remote opportunity to conduct utilization management - chart reviews for a brand name specialty benefits company. We are seeking several physicians with a board certification in Medical Oncology/...
- 30 Days Ago
Claims Representative - Auto
- Sedgwick Claims Management Services Inc.
-
Prairie, WI
OTHER
- Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
- 4 Days Ago
Claims Analytics Manager
- West Bend Insurance Company
-
West, WI
FULL_TIME
- Company Overview Recognized as a Milwaukee Journal Sentinel Top Workplace for 12 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that ou...
- 2 Months Ago
Medical Claims Review Manager jobs at Popular Companies
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
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
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
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
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
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
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
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
About Wisconsin
Wisconsin is bordered by the Montreal River; Lake Superior and Michigan to the north; by Lake Michigan to the east; by Illinois to the south; and by Iowa to the southwest and Minnesota to the northwest. A border dispute with Michigan was settled by two cases, both Wisconsin v. Michigan, in 1934 and 1935. The state's boundaries include the Mississippi River and St. Croix River in the west, and the Menominee River in the northeast.
With its location between the Great Lakes and the Mississippi River, Wisconsin is home to a wide variety of geographical features. The state is divided into five dist...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$96,848 to $123,482
Most Popular Cities in Wisconsin 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 examiners view of a particular bills status in a claim records related bill screen, or a bill review analysts 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