Medical Claims Review Manager jobs in Monroe, LA

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)

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Loan Review Specialist
  • Business Alliance Financial Services LLC
  • Monroe, LA FULL_TIME
  • Job purpose

    To provide an objective appraisal to credit union management of Member Business Loans and applications for credit in order to identify potential loan problems and ensure compliance with established loan policies and federal regulations.


    Duties and responsibilities

    Primary Duties:

    • Performs regular loan portfolio reviews based on risk and/or size of all credit types (commercial real estate, equipment, Small Business Administration, asset-based lines of credit, participations, etc.) that cover the following areas:
      • Asset Quality – Ensuring that acceptable credit standards are maintained (confirms lien perfection, repayment capacity, collateral, etc.)
      • Documentation – Ensuring that loans conform to established bank lending policies and procedures and that required documents have been obtained and are thorough and accurate.
      • Compliance – Ensuring conformance to relevant state and federal laws and regulations.
    • Ensures the creditworthiness of the loan portfolio, looking for changes that merit a review of lending practices and/or adverse asset classification
      • Validates the accuracy of the credit grading/loan rating system
        • Evaluates the allowance for loan loss methods/reserves/allocations/watch list
      • Identifies problem loans and describes deficiencies
        • Recommends final credit grades for approval by supervisor of loan review function
        • Provides detailed reasons/rationale for assigning differing and/or adverse risk ratings
      • Identifies and evaluates portfolio trends with respect to delinquency, bankruptcy, demographic and other factors
      • Monitors portfolio diversification in accordance with policy guidance and strategic plan
      • Stress tests the loan portfolio or individual loans for risk monitoring
    • Reviews credit union processes (loan approvals, policy exception reporting, supervisory loan to value limits, underwriting, covenants, internal controls, concentration reporting, ALLL methodology, etc.)
      • Evaluates the adequacy and effectiveness of tracking systems
      • Determines if proper approval procedures and loan authorities are adhered to
      • Reports trends and/or makes suggestions for changes
      • Informs management of any potential fraud opportunities and/or detection
    • Verifies quality, completeness and accuracy of supporting loan documentation and analysis
      • Periodically reviews files for appraisals, deeds of trust, UCC filings, perfection on liens, collateral evaluations and valuations, etc.
      • Performs regular back-end review of financials and related analysis (financial statements, tax returns, rent rolls, personal financial statements, cash flow statements, etc.)
        • Identifies trends, debt service coverage, performance ratio analysis
    • Reviews loan policy for adequacy
      • Validates that applicable laws and regulations are addressed by policy
      • Ensures that actual procedures/processes uphold the written policy
      • Makes suggestions/recommendation for changes/updates/revisions to policy content
    • Assesses problem loan management/workout plan effectiveness
    • Provides assistance and consultation to loan officers, other lending personnel (loan administration, lending assistants, etc.), auditors and regulatory examiners.
    • Prepares an executive summary of each review and supporting analysis
      • Creates write-ups for presentation to individual lenders and/or management
      • Presents findings to Board of Directors as appropriate
    • Participates in special lending-related projects as directed
    • Performs additional job-related duties as assigned or required


    Other Responsibilities:

    • Other duties as assigned


    Qualification – Minimum Requirements

    • Bachelor’s Degree with an emphasis in finance or accounting – or equivalent combination of education and experience (5 years) required.
    • Minimum of three (3) years’ experience in a loan review or credit analysis capacity is required.
    • Must exhibit strong analytical skills, recognizing the importance of attention to details.
    • Must have the ability to multitask to meet deadlines and deal tactfully with clients.
    • Computer aptitude with MS Office programs, Word, Excel, Adobe, Access and PowerPoint.

    Key Success Factors:

    • Thorough knowledge of lending laws and regulations
    • Strong analytical, technical and statistical skills
    • Sound working knowledge of accounting principles and financial statements
    • Ability to create reports of review findings
    • Capability to effectively present information and respond to questions form groups of lenders, managers, directors and/or regulatory officials
    • Strong integrity in all areas, adhering to policies, regulations and utmost ethical and legal standards
    • Uphold confidentiality and privacy of findings in all situations
    • Demonstrate ability to prioritize and handle multiple projects
    • Remain flexible to withstand unpredictable changes to schedules and deadlines
    • Interact and communicate effectively with personnel at all levels of the organization


    Desirable Performance Behaviors:

    • Ability to interact easily at all levels of the organization
    • Flexibility in working with team members to meet deadline
    • Commitment to excellence and attention to detail
    • Exhibit professional behavior
    • Ability to work on multiple projects while meeting tight deadlines and achieving expected level of accuracy


    Equipment/Software Operating Requirements;

    Windows based PC (MS Word/Excel/Power Point/Outlook

    Familiar with Bank CORE syatems

    Document Imaging

    copy machine; telephone


    Working conditions

    • Normal business office environment in a professional business setting.
    • Occasional travel to credit union locations and off-site vendors.
    • Work pace can be very fast during deadlines and peak periods.


    Physical requirements

    • Operation of a Personal Computer and viewing information on a monitor
    • Must be able to sit for many hours each day
    • Ability to sit in artificial light for extended periods of time.
    • Must be able to communicate via telephone and possess dexterity to include filing document, reaching, and bending
    • May be required to stand for extended periods of time
    • Ability to lift or carry up to 20 pounds
    • Ability to speak English, express ideas and have difficult conversations in person and over the phone
    • Ability to listen and comprehend speech
    • Ability to problem solve, make decisions, interpret data and information, read, write, and organize information in an orderly manner
  • 1 Month Ago

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Paid Product Tester
  • Product Review Jobs
  • Strong, AR FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • Just Posted

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Paid Product Tester
  • Product Review Jobs
  • Spearsville, LA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • Just Posted

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Paid Product Tester
  • Product Review Jobs
  • HUTTIG, AR FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 24 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • CALION, AR FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 24 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • CHOUDRANT, LA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 24 Days Ago

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0 Medical Claims Review Manager jobs found in Monroe, LA area

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Denial & Appeals Coordinator, Concurrent Denials Prevention, FT, 08:30A-5P
  • Baptist Health
  • Monroe, LA
  • Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 24,000 e...
  • 4/24/2024 12:00:00 AM

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Travel Physical Therapist-Tennessee
  • Hiring Now!
  • Monroe, LA
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/24/2024 12:00:00 AM

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Travel Physical Therapist-Oregon
  • Hiring Now!
  • Monroe, LA
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/24/2024 12:00:00 AM

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Travel Physical Therapist-Georgia
  • Hiring Now!
  • Monroe, LA
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/24/2024 12:00:00 AM

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Travel Physical Therapist-Pennsylvania
  • Hiring Now!
  • Monroe, LA
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/23/2024 12:00:00 AM

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Travel Physical Therapist-Nebraska
  • Hiring Now!
  • Monroe, LA
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/23/2024 12:00:00 AM

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Travel Physical Therapist-Alabama
  • Hiring Now!
  • Monroe, LA
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/23/2024 12:00:00 AM

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Travel Physical Therapist-Wisconsin
  • Hiring Now!
  • Monroe, LA
  • Overview: Explore ATI (Passport and Launch) are travel programs for physical therapists that offers short term and long ...
  • 4/23/2024 12:00:00 AM

Monroe (historically French: Poste-du-Ouachita) is the eighth-largest city in the U.S. state of Louisiana. It is the parish seat of Ouachita Parish. In the official 2010 census, Monroe had a population of 48,815. The municipal population declined by 8.1 percent over the past decade; it was 53,107 in the 2000 census. After a recheck in 2012, the Census Bureau changed the 2010 population from 48,815 to 49,147. Mayor Jamie Mayo, however, maintains that the Monroe population is more than 50,000 and indicated that he will pursue a continued challenge to the count. Monroe is the principal city of t...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$87,912 to $112,089
Monroe, Louisiana area prices
were up 1.2% from a year ago

Medical Claims Review Manager in Paramus, NJ
Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.
February 01, 2020
Medical Claims Review Manager in Nashua, NH
By truly combining claims and bill review, the two systems are kept in sync utilizing the scheduled jobs of the aforementioned standard model; however, for real-time data updates, claims examiners are granted access to the entire live bill review system.
January 13, 2020
Medical Claims Review Manager in Davenport, IA
Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.
January 03, 2020