Medical Claims Review Manager jobs in Wilmington, NC

Responsibilities: 

• Directing the day-to-day activities of the staff at the clinic, ensuring a high level of productivity. Continually monitoring the functioning of the clinic and revising operations as needed. 
• Overseeing all functions of the medical group including reception and scheduling activities, patient service areas, medical records, appropriate clinical areas. Establishing effective policies and procedures for each area, updating as necessary. 
• Ensuring revenue cycle management by making sure patient demographic information is accurate and timely, pre-authorizations are completed by carrier guidelines for medical services, and ensuring support for medical necessity of services rendered. 
• Being responsible for efficient systems, which provide quality patient services and overall patient satisfaction throughout the clinic. 
• Ensuring fiscal responsibility as it pertains to supplies, drugs, other professional services, FTEs and overtime. 
• Establishing and maintaining effective communication and working relationships with physicians. Responding to physician concerns and providing problem resolution as appropriate. 
• Compliance with process improvement initiatives and system changes/implementations. 
• Maintaining current knowledge of applicable local, state and federal codes and regulations and ensuring compliance. 
• Performing human resource responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, salary adjustments, resolution of employee concerns, disciplinary counseling, terminations, and employee morale. 

Minimum Requirements: 

• 3-5 Years of management experience required. 
• LPN or RN preferred or Bachelors Degree in Health Care Administration or related field.  
• Strong physician relation skills required. Prior experience and efficiency in an EHR and Microsoft Office applications. 
• Strong time management and prioritization skills required. 
• Excellent communication skills necessary for assessment and management of patient, family or staff concerns. 

 Benefits:  

• 401(k)  
• Health, Dental and Vision insurance  
• Employee assistance program  
• AFLAC
• Paid time off