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)
About Alaffia & Our Mission
The U.S. healthcare system suffers from over $300B in improper payments each year due to fraud, waste, abuse, and processing errors. We’re on a mission to change that. To best prevent inaccurate payments, we’ve assembled a team of experienced technologists and industry-leading healthcare domain experts. The Alaffia team has alumni ranging from Amazon, Goldman Sachs, the Centers for Medicare and Medicaid Services, and other leading healthcare and financial institutions. We’re also backed by industry-leading venture capital firms!
If you want to make a major impact at the core of U.S. healthcare by implementing the latest in cutting-edge technologies, then we’d like to meet you.
Our Culture
At Alaffia, we fundamentally believe that the whole is more valuable than the sum of its individual parts. Further to that point, we believe a diverse team of individuals with various backgrounds, ideologies, and types of training generates the most value. Our people are entrepreneurial by nature, problem solvers, and are passionate about what they do — both inside and outside of the office.
About the Role & What You’ll Be Doing
As a Payment Integrity Manager at Alaffia, you'll play a crucial role in overseeing and optimizing our Payment Integrity Analysts (PIA) team's performance to ensure accurate and efficient bill reviews. Drawing on your expertise in healthcare operations and working in a payer environment, you'll guide day-to-day operations, track performance metrics, and implement strategies to enhance operational efficiency and effectiveness.
With your clinical background and industry knowledge, you'll lead by example, demonstrating best practices in bill review processes and advocating for ongoing training and development opportunities for the team. Additionally, you'll be responsible for developing and documenting standard operating procedures (SOPs) for various types of claim reviews and payer types. Your contributions will be instrumental in ensuring the success and growth of our Payment Integrity team, ultimately driving value for our clients and helping Alaffia achieve its operational goals.
Your Responsibilities
What We’re Looking For
What Else Do You Get Working With Us?
Employer-sponsored Medical, Dental, and Vision benefits
Flexible, paid vacation policy
Work in a flat organizational structure — direct access to Leadership
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