Claims Review Manager

Naphcare, Inc.; Edgemont (AL); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401K

Tuition assistance

Referral bonuses

Paid time off

CMEs

Job summary

NaphCare, Inc. is seeking a Claims Review Manager at our Corporate Headquarters in Birmingham, AL. You will lead a team reviewing medical authorizations and reconciling claims, partnering with scheduling to ensure timely processing and accuracy.

Ideal candidates bring healthcare claims experience, strong data handling skills, and a focus on process improvements to boost efficiency and reduce errors. This role offers growth within a large correctional healthcare provider.

Qualifications

• High School Diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, business, or related field preferred.
• Three (3) years minimum experience in a healthcare claims, billing or medical authorization setting.
• Ability to prioritize, delegate, and meet deadlines in a high-volume environment.
• Working knowledge of medical claims, medical terminology, medical records, and medical authorization processes.
• Strong written, verbal and organizational skills.
• Working knowledge of claim demographic information.
• Computer skills, including proficiency in Microsoft Office Suite, particularly Excel.

Responsibilities

• Oversee a team of claims specialists reviewing authorizations for medical procedures and reconciling claims.
• Review medical authorizations in scheduling system to resolve outstanding claims.
• Manage team to ensure timely work with minimal errors and meet internal deadlines.
• Develop and deliver regular reports on team analytics and KPIs.
• Identify and resolve operational challenges, proposing process improvements.
• Maintain confidentiality of medical records and patient data.
• Work with large data volumes and maintain high accuracy.

Skills

Data entry

Attention to detail

High-volume processing

Education

Healthcare administration degree preferred

Tools

Microsoft Excel

Job description

Overview

NaphCare has an excellent opportunity for a Claims Review Managerto join ourCorporate HeadquartersinBirmingham, AL supporting our scheduling teams. The successful Claims Review Manager will play a critical role in our operations by overseeing a team of claims specialists that review authorizations for medical procedures/appointments and reconciling claims. This position requires data entry skills and the ability to maintain a high volume of work with minimal errors. This employee will serve as a liaison between the scheduling and claims department to assist with timely processing of claims.

Responsibilities

• Utilize healthcare experience to consistently review medical authorizations in our scheduling system in order to resolve outstanding claims


• Demonstrate skills in accuracy and multitasking while working to impact progress within the daily workload and adhere to internal deadlines


• Manage team of Claims Review Specialists to ensure that claims are being worked timely with minimal errors


• Develop and deliver regular reports on team analytics and key performance metrics


• Independently identify and resolve operational challenges, and proactively recommend and implement improvements to processes and workflows that increase efficiency and accuracy


• Maintain confidentiality when managing medical records, patient data, and NaphCare processes


• Demonstrate a high comfort level in working with large volumes of data


• Demonstrate a strong attention to detail


• Additional duties and specific projects as assigned

Qualifications

• High School Diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, business, or a related field preferred.


• Three (3) years minimum experience in a healthcare claims, billing or medical authorization setting.


• Ability to prioritize, delegate, and meet deadlines in a high volume environment.


• Working knowledge of medical claims, medical terminology, medical records, and medical authorization processes.


• Strong written, verbal and organizational skills.


• Working knowledge of claim demographic information.


• Computer skills, including proficiency in Microsoft Office Suite, particularly Excel.

Why Join NaphCare?

NaphCare is one of the largest providers of healthcare services to correctional facilities throughout the US and we are growing. If you have never considered a career in correctional healthcare, now may be the time. In addition to competitive salaries and generous employee benefits, we strongly support career advancement within the company.

NaphCare Benefits for Full-Time Employees Include:

• Health, dental & vision insurance that starts day one!


• Prescriptions free of charge through our health plan, beginning day one!


• Lowest Cost Benefits!


• Employee Assistance Program (EAP) services


• 401K and Roth with company contribution that starts day one!


• Tuition Assistance


• Referral bonuses


• Term life insurance at no cost to the employee


• Generous paid time off & paid holidays


• Free continuing education and CMEs

Equal Opportunity Employer: disability/veteran