Medical Claims Review Manager jobs in Rochester, NY

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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Jr Systems Analyst
  • Claims Recovery Financial Services
  • Albion, NY FULL_TIME
  • Job Title: Jr. Systems Analyst Department: Information Technology

    Reports To:
    President FLSA Status: Exempt

    Position Summary
    An individual in this role will serve as the bridge between operational needs and the technology available to fill those needs quickly, accurately, and cost-effectively. This individual will interact with stakeholders across the organization, understand business process, identify improvement opportunities, prioritize company efforts on high-impact projects and ensure desired results are achieved. The ability to communicate effectively, manage indirect resources while also participating as a contributor is paramount to success.

    Essential Duties & Responsibilities
    • Understand and document business needs through direct interaction with Operations and Clients.
    • Facilitate organization wide process improvement initiatives.
    • Apply an understanding of the capabilities of technology to solve business problems.
    • Collaborate with internal and external users to understand and document business needs.
    • Design and implement solutions within approved technology toolsets that are reliable, scalable, and meet business needs
    • Complete testing and validation of both individually and peer work to ensure quality solutions.
    • Facilitate functionality reviews and user acceptance testing with stakeholders.
    • Ensures smooth transition of solutions to production, and user acceptance, by providing training and other support as needed.
    • Troubleshoots production issues and bugs to affect timely resolution and minimize business impact.
    • Follows the CRFS System Development Life Cycle in all development activities.
    • Documents all work and associated efforts within CRFS work management system.
    • Updates job knowledge by seeking educational opportunities; reading professional publications and taking on a diverse set of assignments.
    • Other responsibilities as required by business needs and delegated by senior analysts

    Qualifications

    • Prior experience in one or more of the following technologies: SQL Development, Database Development, or SSRS.
    • Knowledge on database T-SQL, stored procedures, basic administration
    • Experience with the Microsoft Office suite.
    • Strong analytical skills, as well as customer service.
    • Ability to balance competing priorities, complex situations, and tight deadlines.
    • Demonstrated attention to detail and ability to work independently.
    • Strong communication skills; demonstrating professionalism, patience, and respect through verbal and written tone.
    • Ability to maintain a high level of confidentiality.


    Claims Recovery Financial Services is committed to equal opportunity for all, without regard to race, religion, color, national origin, citizenship, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, or any other protected characteristic. Claims Recovery Financial Services will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities unless the accommodation would impose an undue hardship on the operation of our business. If you are interested in applying for an employment opportunity and feel you need a reasonable accommodation pursuant to the ADA, please contact us at 585-331-9128.
  • 29 Days Ago

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Jr Systems Analyst
  • Claims Recovery Financial Services
  • Rochester, NY FULL_TIME
  • Job Title: Jr. Systems Analyst Department: Information Technology Reports To: President FLSA Status: Exempt Position Summary An individual in this role will serve as the bridge between operational nee...
  • 30 Days Ago

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Civil Engineer - Project Engineer / Manager
  • Project Engineer / Manager - LaBella Associates
  • Rochester, NY FULL_TIME
  • We are in search of a capable candidate to play a key role in a broad spectrum of projects, encompassing everything from large utility infrastructure projects and athletic fields to land development w...
  • 16 Days Ago

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Garage Clothing-Store Manager-Eastview Mall-Victor, NY
  • Garage clothing-Store Manager-Eastview...
  • Victor, NY FULL_TIME
  • Seize the opportunity to join a global fashion retailer with two brands at the heart of its success, Garage and Dynamite, selected as one of Montreal's Top Employers 2020 and as one of Canada’s Top em...
  • 9 Days Ago

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Store Manager
  • Garage clothing-Store manager-Eastview mall-Victor...
  • Victor, NY FULL_TIME
  • Seize the opportunity to join a global fashion retailer with two brands at the heart of its success, Garage and Dynamite, selected as one of Montreal's Top Employers 2020 and as one of Canada’s Top em...
  • 20 Days Ago

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Taco Bell General Manager
  • Taco Bell Manager- Indus Hospitality Group
  • Macedon, NY FULL_TIME
  • Taco Bell Restaurant Manager Taco Bell - Macedon, NY Description Indus Hospitality Group’s mission is developing, empowering, and supporting success in our employees. At the core of our brand we stand...
  • 14 Days Ago

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0 Medical Claims Review Manager jobs found in Rochester, NY area

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Remote Licensed Professional Counselor
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/24/2024 12:00:00 AM

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Remote Licensed Marriage and Family Therapist
  • Headway
  • Rochester, NY
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/23/2024 12:00:00 AM

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Registered Nurse - Emergency Room - Nights
  • Confidential Client
  • Rochester, NY
  • Overview: Short Term Assignment Regular Pay Rate: $70 Overtime Pay Rate: $97.50 POSITION DESCRIPTION The Registered Nurs...
  • 3/8/2024 12:00:00 AM

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Registered Nurse - ICU - Days
  • Confidential Client
  • Rochester, NY
  • Overview: Assignment Length: Ongoing Job Description Short Term Assignment Regular Pay Rate: $70 Overtime Pay Rate: $97....
  • 3/8/2024 12:00:00 AM

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Registered Nurse - ICU - Nights
  • Confidential Client
  • Rochester, NY
  • Overview: Assignment Length: Ongoing Job Description Short Term Assignment Regular Pay Rate: $70 Overtime Pay Rate: $97....
  • 3/8/2024 12:00:00 AM

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Registered Nurse - Med/Surg Telemetry - Days
  • Confidential Client
  • Rochester, NY
  • Overview: Assignment Length: Ongoing Job Description Short Term Assignment Regular Pay Rate: $70 Overtime Pay Rate:$97.5...
  • 3/8/2024 12:00:00 AM

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Registered Nurse - Emergency Room - Days
  • Confidential Client
  • Rochester, NY
  • Overview: Assignment Length: Ongoing Job Description Short Term Assignment Regular Pay Rate: $70 Overtime Pay Rate: $97....
  • 3/8/2024 12:00:00 AM

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Registered Nurse - Med/Surg Telemetry - Nights
  • Confidential Client
  • Rochester, NY
  • Overview: Assignment Length: Ongoing Job Description Short Term Assignment Regular Pay Rate: $70 Overtime Pay Rate:$97.5...
  • 3/8/2024 12:00:00 AM

Rochester is at 43°9′56″N 77°36′41″W / 43.16556°N 77.61139°W / 43.16556; -77.61139 (43.165496, −77.611504). The city is about 73 miles (120 km) east-northeast of Buffalo and about 87 miles (140 km) west of Syracuse and Albany, the state capital is 226 miles (360 km) to the east ; it sits on Lake Ontario's southern shore. The Genesee River bisects the city. Toronto, Canada is northwest 168 miles (270 km) and New York City is about 350 miles (560 km) to the southeast. According to the United States Census Bureau, the city has a total area of 37.1 square miles (96 km2), of which 35.8 square m...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$96,011 to $122,415
Rochester, New York area prices
were up 1.5% 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