HBA Claims Manager

Position Summary

At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a Claims Manager with experience in claims processing and the assignment of claims to work within our auditing department.

The Claims Manager oversees the claim assignment and screening queues to ensure claims are completed by the nurses within the appropriate time frames. He or She will work collaboratively with The Document Management Support Team and the Nursing Leadership to ensure claims flow through our proprietary system appropriately. This individual will be responsible for medical record screening, claim assignment of escalated/expedited reviews to the nurses, and ensuring that claims have been manually transcribed and processed correctly. The Claims Manager will troubleshoot issues related to discrepancies between both the Itemized bill and universal bill, and access client systems for claim payment information as needed.

Candidate should be highly motivated. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.

This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.

If you are interested in this role with MedReview, please let us know. Here is what we are searching for:

Responsibilities

• Works collaboratively with the nursing leadership to ensure claims are completed timely per the client’s SLA (service level agreement).
• Interface with Nursing Leadership regarding operational issues affecting the processing of claims
• Assist with IB transcription and automation monitoring.
• Screens claims as needed to ensure that the appropriate medical records are available for claim review.
• Assigns expedited/escalated claims to the nurses for review.
• Access client systems for claim payment information.
• Takes appropriate action when encountering discrepancies between both the Itemized bill and universal bill.
• Manages non-clinical claim inquiries via Medreview’s proprietary ticketing system (HALO).
  
  

Qualifications

• College Graduate – Bachelor’s or an Associate degree
• Minimum of two years’ experience in claims processing or payment integrity required.
• Experience/knowledge of medical records is preferred
• Detail oriented highly organized work and time management skills.
• Excellent computer skills.
• Demonstrates the ability to motivate others.
• Positive attitude who works well with others.
• Willingness to improve workflow.
• Demonstrates commitment to NYCHSRO/MedReview values.
• Shows adaptability through handling day-to-day work challenges confidently, willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change, showing resilience in the face of constraints, frustrations, or adversity, and demonstrating flexibility
  
  

Remote Work Requirements

• High speed internet (100 Mbps per person recommended) with secured WIFI.
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information
• Must be able to sit and use a computer keyboard for extended periods of time
  
  

Benefits and perks include:

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
• Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional
  
  

Salary Rate: $70,000/Annually.

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