Medical Claims Review Manager jobs in Toledo, OH

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)

Recently Added Medical Claims Review Manager jobs

B
Medical Records Review Coordinator
  • BizTek People, Inc. | APA International Placement Consultants
  • Maumee, OH FULL_TIME

  • Title: Medical Records Review Coordinator

    Duration: 12 Weeks

    Location: Maumee, OH

     

    JOB DESCRIPTION

    • Performs audits of medical records from primary care and specialty provider offices to collect medical facts based on regulatory agency criteria to support insurance plan quality ratings and re-credentialing.
    • Compiles results and enters data into an electronic database of medical record information.
    • Communicates directly with provider offices via telephone, fax, or email to facilitate medical record collection.
    • Must handle a high volume of reviews in a timely manner while ensuring accuracy.
    • Ability to learn and understand medical terminology.
    • Highly-detail oriented and organized.
    • Previous experience with medical charts and terminology is required.


    Requirements

    REUIREMENTS
    • Must have experience with HEDIS medical records review process.
    • Someone who has or previously held an RN license, Medical Assistant, CNA, or LPN.
    • Another alternative is a Medical Coder who does have a current and valid certification.
    • Maybe a Medical Assistant who switched fields from clinical to HIM tech. Or an RN who previously was a HIM Tech and is now an RN



  • 19 Days Ago
Apply this Job
P
Quality Review
  • PALFINGER
  • Tiffin, OH OTHER
  • The PALFINGER values of People, Entrepreneurship, Respect and Learning are more than words. We strive daily to create and support an atmosphere of collaboration, transparency, empowerment and customer...
  • 1 Month Ago
Apply this Job
Z
Utilization Review & Credentialing Specialist
  • ZEPF CENTER
  • Toledo, OH FULL_TIME
  • Description Zepf Center has been serving the Lucas County community for nearly 50 years. We are the leading provider of behavioral health and substance use disorder services in Northwest Ohio. Service...
  • 12 Days Ago
Apply this Job
C
Claims Specialist
  • COMMUNITY AND RURAL HEALTH SERVICES
  • Fremont, OH OTHER
  • Job Details Level: Experienced Job Location: Main - Fremont, OH Position Type: Full Time Education Level: 2 Year Degree Salary Range: $19.50 Hourly Travel Percentage: Up to 25% Job Shift: Day Descript...
  • 2 Days Ago
Apply this Job
C
Claims Specialist
  • Community and Rural Health Services
  • Fremont, OH FULL_TIME
  • Community Health services is seeking a full time Claims Specialist to work in our Fremont office. CHS employs those who are eager to grow professionally, gain great experience, and work with a terrifi...
  • 9 Days Ago
Apply this Job
A
Unit Manager
  • American Medical Associates
  • Toledo, OH FULL_TIME
  • A beautiful, privately owned skilled nursing facility located in Toledo, OH is looking for a strong Unit Manager. Responsibilities: Assist with patient’s examinations and/or questions. Implement and i...
  • 2 Days Ago
Apply this Job
View All Medical Claims Review Manager Jobs
Salary Company Skills How To Become Job Openings
Filters

Clear All
  • Filter Jobs by companies
  • More
Salary Company Skills How To Become Job Openings

0 Medical Claims Review Manager jobs found in Toledo, OH area

H
Remote Licensed Mental Health Counselor
  • Headway
  • Toledo, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM
Apply this job
H
Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Toledo, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM
Apply this job
H
Remote Licensed Clinical Psychologist
  • Headway
  • Toledo, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM
Apply this job
H
Remote Licensed Mental Health Therapist
  • Headway
  • Toledo, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM
Apply this job
H
Remote Licensed Clinical Psychologist
  • Headway
  • Toledo, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/25/2024 12:00:00 AM
Apply this job
H
Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Toledo, OH
  • 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
Apply this job
H
Remote Licensed Marriage and Family Therapist
  • Headway
  • Toledo, OH
  • 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
Apply this job
H
Remote Licensed Clinical Social Worker
  • Headway
  • Toledo, OH
  • 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
Apply this job
View All Medical Claims Review Manager Jobs

About Toledo, Ohio

Toledo (/təˈliːdoʊ/) is a city in and the county seat of Lucas County, Ohio, United States. Toledo is in northwest Ohio, at the western end of Lake Erie bordering the state of Michigan. The city was founded in 1833 on the west bank of the Maumee River, and originally incorporated as part of Monroe County, Michigan Territory. It was re-founded in 1837, after conclusion of the Toledo War, when it was incorporated in Ohio. After the 1845 completion of the Miami and Erie Canal, Toledo grew quickly; it also benefited from its position on the railway line between New York City and Chicago. The first...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$94,254 to $120,176
Toledo, Ohio area prices
were up 1.3% from a year ago
View detail

What does a Medical Claims Review Manager do?

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