Claims Manager

Summary

Join MedReview, a leader in payment integrity solutions, as a Claims Manager! You will oversee claim assignment and screening, ensuring timely completion by nurses. Collaborate with the Document Management Support Team and Nursing Leadership to optimize claim flow. Responsibilities include medical record screening, claim assignment, and troubleshooting discrepancies. This full-time, remote position requires a Bachelor's or Associate's degree and at least two years of claims processing experience. Excellent communication and analytical skills are essential. MedReview offers competitive benefits, including healthcare, 401(k) matching, generous PTO, wellness programs, and professional development opportunities.

Requirements

• College Graduate – Bachelor’s or an Associate degree
• Minimum of two years’ experience in claims processing or payment integrity
• 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
• 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

Responsibilities

• Work 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
• Screen claims as needed to ensure that the appropriate medical records are available for claim review
• Assign expedited/escalated claims to the nurses for review
• Access client systems for claim payment information
• Take appropriate action when encountering discrepancies between both the Itemized bill and universal bill
• Manage non-clinical claim inquiries via Medreview’s proprietary ticketing system (HALO)

Preferred Qualifications

Experience/knowledge of medical records

Benefits

• 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