Medical Claims Review Manager jobs in Kingsport, TN

Job Summary:

The Clinical Chart Review will serve as an adjunct to the patient’s care provider to coordinate their maintenance healthcare needs designed to optimize health for a variety of disease conditions such as diabetes, hypertension, hyperlipidemia, and others. The Clinical Chart Review will initiate care and orders for assigned patients based on a predetermined process to ensure the desired outcome. This individual is responsible for all scheduled patients for all providers within an assigned office. The Clinical Chart Review ensures to maintain communication with all providers and other healthcare staff in the office to ensure that quality, patient-centered care is provided.

Duties/Responsibilities:

• Be a valued member of the clinical team in providing patient-centered care

• Review and flag all scheduled patient charts using an electronic alert to indicate an area that the provider needs to address during the patient’s upcoming visit

• Identifies clinical opportunities where follow-up care is needed

• Order diagnostic testing as needed based on the algorithm/process as predetermined by nursing management and provider

• Manage variable from the algorithm that include (variables are dynamic):

a. Fall Risk Assessment

b. Smoking Cessation

c. BMI (Body Mass Index)

d. Mammogram

e. Bone Density

f. Pneumovax (Pneumonia vaccine)

g. Fecal Occult

h. Diabetic measures

• Communicate with providers and other healthcare staff as needed to assist with other tasks in the office

• Performs other duties as assigned

Education and Experience:

• Minimum High School diploma or equivalent required

• LPN licensed by the state in which employed or Registered/Certified Medical Assistant

• 3-5 years’ experience nursing and utilizing an EMR system

Knowledge:

• Ability to work independently with strict adherence to protocols in an accountable manner

• Detail Oriented

• Excellent communication skills both written and oral

• Superb time-management, organizational and problem-solving skills

Supervisory Responsibilities:

• None

Competencies:

• Accountability – Accepting responsibility that results in anticipation/prevention of problem areas from actions, and problem solving and outside the department/organization.

• Customer focus – knowing the patient needs and acting; accordingly, anticipating needs, and giving high priority to patient satisfaction and customer service.

• Empathy – Showing interest in other people’s feelings, attitudes, and reasoning.

• Integrity – Upholding generally accepted social and ethical standards in job-related activities and behaviors.

• Quality Orientation – Setting high standards regarding his/her work and working environment and acting; accordingly, developing quality standards, continuously evaluating performance, products, and procedures; actively seeking ways to improve quality.

• Strategic Thinking – Understands and processes complex information and exercises sound judgement, considering the situation, the issues, the key players and the levels of authority involved. Proposes courses of action that further the objectives, priorities, and vision of the organization.

• Teamwork – Working as a productive member of a cohesive group toward a common goal and contributing to learn development and effective team dynamics.

Physical/Mental Demands:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential: Communication with others to exchange or express information and ideas. Ability to receive detailed information through oral communication, and to make fine distinctions in sounds. Determine the accuracy, neatness, thoroughness of the work assigned and perceive general observations. Remaining upright on the feet, particularly 75% of the time. Moving about on foot to accomplish tasks. Bending body downward and forward by bending spine at the waist and/ or by bending leg and spine. Extending the hands and arms in any direction. Exerting force upon an object so that an object moves away/toward the force. Picking, pinching, typing or otherwise working, primarily with fingers. Applying pressure to an object with the fingers and palm. Perform a variety of duties, often changing from one task to another of a different nature. Perform with frequent interruptions and/ or distractions. Make appropriate job decisions following standard office policies and past precedents. Adjust priorities quickly as circumstances dictate. Ability to establish and maintain cooperative working relationships with co-workers and the public. Ability to interact appropriately with colleagues and patients for different purposes and different context.

Marginal: Must be able to remain in a stationary position at least 25% of the time. Medium work that includes moving objects up to 50 pounds occasionally. Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. Work independently and identify potentially more effective methods of work operations. Observing an area that can be seen up and down or to right or left while eyes are fixed on a given point. Ability to identify and distinguish colors.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management reserves the right to revise the job or to require that other or different tasks be performed as assigned.

All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities.

Education

• High School or better in General Studies

Licenses & Certifications

• Basic Life Saving
• Cert Medical Assistant
• Licensed Practical Nurse
• Registered Medical Assist