Medical Claims Review Manager jobs in Tampa, FL

Imagenet LLC is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. Our core business is helping our clients reduce costs and increase productivity by providing efficient document imaging, data validation, adjudication and on demand retrieval of documents and data.

JOB OVERVIEW

Ensure compliance will all corporate and departmental standards. Meet with employees on a regular basis to discuss performance and quality. Report on Key Performance Metrics (KPIs) to the Executive Director of Claims and the Director of Operations to ensure adequate resources and technology are in place. Develop and implement departmental standards and expectations. Analyze and process a variety of claim files to ensure the execution of standardized claim protocol and claim handling.

RESPONSIBILITIES

• Oversee the claims adjudication process to assure that the examiners are following all CMS rules and regulations in conjunction with the insurance company guidelines
• Ensure that the department practices meet or exceed the client’s processing standards, procedures and service level agreements
• Responsible for new Claims Analyst training and auditing of trainee claim processing
• Review Medicare services for appropriateness of charges and will apply pre-existing guidelines during claims processing;
• Pend claims and order Medical records for review and investigation of possible gross misrepresentation
• Authorize claim payments within established limits; otherwise forward to Claims Analyst 2
• Oversee and provide secondary review of pending cases and Medical Records ordered by Claims Analyst 1 for appropriate processing;
• Process refunds and letters of dual coverage (when applicable);
• Must be knowledgeable in CPT-4, ICD-9 and be familiar with medical terminology;
• Identify process improvement opportunities within the claim department and recommend system enhancements
• Handles any additional responsibility which may be assigned

Technical Skills/Knowledge

• Health claims processing
• Basic to intermediate math
• Medical terminology; ICD-9 & ICD-10
• MS Office
• Ability to work independently or within a team
• Time management
• Written and verbal communication
• Attention to detail
• Must be able to demonstrate sound decision-making
• Must be local to Tampa area and work out of the Tampa office

Job Type: Full-time

Experience:

• claims or claims processing, managing: 3 years (Required)

Work authorization:

• United States (Required)

Job Type: Full-time

Pay: $60,000.00 - $80,000.00 per year

Benefits:

• Disability insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Tampa, FL 33609: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Medical billing: 5 years (Required)
• Management: 5 years (Required)

Work Location: In person

Imagenet LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.