HBA Claims Manager

MedReview Inc.; New York (NY); Remote; USD 70,000; Full time

Job summary

An established industry player is seeking a Claims Manager to enhance their auditing department. This role is crucial for ensuring accuracy and accountability in healthcare claims processing. You will collaborate with nursing leadership, manage claims inquiries, and ensure compliance with client SLAs. The ideal candidate will have a strong background in claims processing, excellent organizational skills, and a commitment to improving workflows. Join a forward-thinking company that values clinical excellence and offers generous benefits, including medical plans, a 401(k) match, and opportunities for professional development.

Benefits

Medical, Dental, and Vision Plans

401(k) with Employer Match

Generous Paid Time Off

Wellness Benefits

Learning & Development Opportunities

Qualifications

• Minimum of two years’ experience in claims processing or payment integrity.
• Detail-oriented with highly organized work and time management skills.

Responsibilities

• Collaborate with nursing leadership to ensure timely claims completion.
• Manage non-clinical claim inquiries via proprietary ticketing system.

Skills

Claims Processing

Medical Records Knowledge

Detail-oriented

Time Management

Computer Skills

Education

Bachelor's Degree

Associate Degree

Tools

HALO Ticketing System

Job description

Position Summary: At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. We are a leading authority in payment integrity solutions, including DRG Validation, Cost Outlier, and Readmission reviews. We are seeking a Claims Manager with experience in claims processing and claim assignment to join our auditing department.

Responsibilities

1. Collaborate with nursing leadership to ensure claims are completed timely per the client’s SLA.
2. Interface with Nursing Leadership regarding operational issues affecting claim processing.
3. Assist with IB transcription and automation monitoring.
4. Screen claims to ensure appropriate medical records are available for review.
5. Assign expedited/escalated claims to nurses for review.
6. Access client systems for claim payment information.
7. Address discrepancies between itemized bills and universal bills.
8. Manage non-clinical claim inquiries via MedReview’s proprietary ticketing system (HALO).

Qualifications

• College Graduate – Bachelor’s or Associate degree.
• Minimum of two years’ experience in claims processing or payment integrity.
• Experience/knowledge of medical records preferred.
• Detail-oriented with highly organized work and time management skills.
• Excellent computer skills.
• Ability to motivate others and work well with a positive attitude.
• Willingness to improve workflow.

Requirements

• Commitment to NYCHSRO/MedReview values.
• Adaptability in handling daily work challenges and shifting priorities.
• High-speed internet (100 Mbps recommended) with secured WIFI for remote work.
• Dedicated workspace minimizing interruptions to protect PHI and HIPAA information.
• Ability to sit and use a computer keyboard for extended periods.

Benefits and Perks

• Medical, dental, and vision plans.
• 401(k) with employer match.
• Generous paid time off and accrued PTO from day one.
• Wellness benefits, including commuter benefits and FSAs.
• Learning & Development opportunities through continued education and LinkedIn Learning.

Salary Rate: $70,000 annually.