Medical Claims Review Manager jobs in Youngstown, 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)

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Medical Claims Examiner
  • Wipro Limited
  • CANFIELD, OH FULL_TIME
  • The Claims Examiner position responsible for processing medical, dental and vision claims.  This position is looking for someone to work in the Canfield Ohio office.  Upon completion of training and satisfactory meeting quality and production goals.  You will be eligible to participate in our corporate hybrid policy that allows you to work part of the week at home and part of the week in the office.

    • Review and process medical claims according to Plan guidelines within established turnaround time frames
    • Interpret medical plan to assure system is coded correctly
    • Review claims for legitimacy and accuracy
    • Meet production and quality standards set for examiners
    • Work Customer Service inquiries related to claim questions
    • Review correspondence submitted by members and providers and adjust all related claims if the additional documentation submitted warrants adjustment
    • Other duties as assigned
    • High School/GED required
    • Demonstrate skills in problem solving and benefit plan interpretation
    • Knowledge of CPT codes, ICD9/ICD10 codes and/or medical terminology is a plus
    • Ability to work independently
    • PC proficiency
    • Average typing ability
  • 2 Days Ago

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Utilization Review Clinician
  • Generations Behavioral Health
  • Youngstown, OH FULL_TIME
  • Job Summary: Responsible for reviewing medical records, preparing clinical appeals (when appropriate) on medical necessity, length of stay, and authorization denials for hospitalized patients. Utiliza...
  • 15 Days Ago

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Utilization Review Specialist
  • Davis Archway Treatment Center
  • Emlenton, PA CONTRACTOR,FULL_TIME
  • Overview:This position reviews clinical documentation to screen for appropriateness of ASAM admission, continued stay criteria, regarding delivery of care, treatment, and services. Utilization Review ...
  • 24 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • KOSSUTH, PA 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...
  • 20 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • Clintonville, PA 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...
  • 21 Days Ago

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Practice Manager | Medical Oncology
  • UPMC
  • Seneca, PA FULL_TIME
  • UPMC Hillman Cancer Center is currently hiring a Practice Manager to support our Medical Oncology Department located at the Hillman Cancer Center in Seneca, PA. This position will be responsible for d...
  • 4 Days Ago

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

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State Tested Nursing Assistant (STNA)
  • Moonlight home health care
  • Youngstown, OH
  • Job Description Job Description Job description We are seeking a compassionate and reliable STNA to join our team and pr...
  • 4/17/2024 12:00:00 AM

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State Tested Nursing Assistant (STNA)
  • Moonlight home health care
  • Austintown, OH
  • Job Description Job Description We are seeking a compassionate and reliable STNA to join our team and provide high-quali...
  • 4/17/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Youngstown, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Youngstown, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Psychiatrist
  • Headway
  • Warren, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Remote Licensed Psychiatric Nurse Practitioner
  • Headway
  • Warren, OH
  • Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients t...
  • 4/15/2024 12:00:00 AM

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Adult Psychiatrist in Oakland, PA
  • LifeStance Health
  • Oakland, PA
  • At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make liv...
  • 4/15/2024 12:00:00 AM

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Psychiatrist, PMHNP FT or PT
  • Supportive Care
  • Sharon, PA
  • Job Description Job Description Supportive Care is looking for Psychiatrists and Psychiatric Nurse Practitioners to join...
  • 4/14/2024 12:00:00 AM

Youngstown is a city in and the county seat of Mahoning County in the U.S. state of Ohio, with small portions extending into Trumbull County. According to the 2010 Census, Youngstown had a city proper population of 66,982, while the Youngstown-Warren-Boardman, OH-PA Metropolitan Statistical Area it anchors contained 565,773 people in Mahoning and Trumbull counties in Ohio, and Mercer County in Pennsylvania. Youngstown is located on the Mahoning River, approximately 65 miles (105 km) southeast of Cleveland and 61 miles (100 km) northwest of Pittsburgh. Despite having its own media market, Young...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$90,937 to $115,946
Youngstown, Ohio area prices
were up 1.3% 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