5 Medical Claims Manger jobs

The Medical Copay Claims Processor plays a critical role in ensuring the smooth and accurate processing of medical copay claims. This position involves meticulous attention to detail, proficiency in handling medical billing software, and excellent communication skills to interact with internal teams, external stakeholders, doctor’s and provider’s offices and patients. Requirements    Key Responsibilities Review and validate medical copay claims for completeness and accuracy.  Ensure all required documentation is included and meets client and regulatory standards. Accurately input claim data into the billing system or electronic health records platform. Navigate and utilize various software applications to process claims efficiently. Apply knowledge of medical coding to ensure accurate benefit is provided. Investigate and resolve discrepancies or issues related to claims, including coding errors, eligibility concerns, rejections, and business rules disputes. Consult with healthcare providers, pharmacies, HUB partners, and patients to obtain necessary information or resolve claim-related inquiries. Collaborate with internal operational and client facing to address claim-related issues. Identify opportunities for process improvement and contribute to the development of best practices. Receive inbound support calls and conduct routine outbound calls to providers offices and patients for various reasons. Supervisory Responsibilities / Accountabilities This position does not have Supervisory Responsibilities/Accountabilities. Required Skills/Abilities: Outstanding customer service skills.  Excellent written and oral skills.  Computer literacy and keyboard typing skills.  Proficiency in Microsoft Office Suites  Ability to work independently and as part of a team in a fast-paced environment.  Problem-solving skills and the ability to handle challenging situations with professionalism and empathy.  Bilingual preferred – English/Spanish. Education and Experience: High school diploma or equivalent.  Must be 18 years of age.  Minimum of 1 year of customer service experience.  Experience in medical billing, and electronic health record systems preferred. Working Conditions      Work is generally performed within an indoor office environment utilizing standard office equipment.       General office environment requires frequent sitting; dexterity of hands and fingers to operate a computer keyboard and       mouse; walking and standing for long periods of time; and lifting less than 20 pounds.  Salary Description $19.00 per hour    

Donor Advocate: Role and Responsibilities: Provide world-class customer care while adhering to all Standard Operating Procedures (SOPs). Perform venipuncture and additional phlebotomy procedures in accordance with SOPs. Collaborate with Leadership and colleagues to maintain efficient donor flow through the donation process from Screening through Disconnect. Collaborate with Medical on all Donor Adverse Events to ensure adherence to all applicable SOPs. Demonstrate our Core Values when interfacing with colleagues, donors, vendors, and all visitors to the center. Ability to maintain professionalism in a highly dynamic environment. Maintain accurate, complete, and concurrent documentation.  Work well with others, sometimes in stressful situations. Add to and maintain a positive team atmosphere and work culture. Other duties as assigned by Leadership.   Center Medical Specialist: Role and Responsibilities: Determine donor suitability in accordance with all applicable regulatory agencies and Company Standard Operating Procedures (SOPs). Perform physical examinations for donors and review accumulated data in a timely manner to confirm established donor suitability. Lead, document, and follow-up on Donor Adverse Events (DAEs). Provide appropriate and confidential counseling, as necessary. Consult with Center Medical Director on all abnormal test results and all medical events. Monitor donors for adverse donation reactions. Determine the need and call for emergency medical assistance when necessary. Always maintain exceptional customer service.    

The Medical Research Assistant is responsible for monitoring and performing various events in clinical studies. This role involves checking in, releasing, and returning study participants, preparing needed materials, obtaining urine samples as required, checking luggage, and ensuring that questionnaires and informed consent forms are completed accurately. The Associate transfers samples to the clinic lab, measures participant height and weight, records raw data, monitors participant activities, and responds to their needs. They are also responsible for keeping study stations well-stocked and clean, including handling and disposing of biohazards, and performing barcoding and interpreting specification sheets.   Additional responsibilities include orienting study participants, performing vital signs, assisting with blood collection and lab work preparation, dosing preparation procedures, and conducting electrocardiograms (ECGs) on participants. The Associate is expected to perform other reasonable duties as assigned.   Qualifications for this position include a high school diploma or GED, with post-high school education in life sciences or medical training preferred. CPR certification and experience in accurate documentation of data are also preferred.

MRC takes non-medical and medical volunteers as long as they are 18 years of age. Many MRC volunteers assist with activities to improve public health in their community – increasing health literacy, supporting prevention efforts, and eliminating health disparities. In an emergency, local resources get called upon first, sometimes with little or no warning. As a member of an MRC unit, you can be part of an organized and trained team that responds during a disaster or public health emergency. You will be ready and able to bolster local emergency planning and response capabilities.    

Imagenet LLC is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. Our core business is helping our clients reduce costs and increase productivity by providing efficient document imaging, data validation, adjudication and on demand retrieval of documents and data. JOB OVERVIEW Ensure compliance will all corporate and departmental standards. Meet with employees on a regular basis to discuss performance and quality. Report on Key Performance Metrics (KPIs) to the Executive Director of Claims and the Director of Operations to ensure adequate resources and technology are in place. Develop and implement departmental standards and expectations. Analyze and process a variety of claim files to ensure the execution of standardized claim protocol and claim handling. RESPONSIBILITIES Oversee the claims adjudication process to assure that the examiners are following all CMS rules and regulations in conjunction with the insurance company guidelines Ensure that the department practices meet or exceed the client’s processing standards, procedures and service level agreements Responsible for new Claims Analyst training and auditing of trainee claim processing Review Medicare services for appropriateness of charges and will apply pre-existing guidelines during claims processing; Pend claims and order Medical records for review and investigation of possible gross misrepresentation Authorize claim payments within established limits; otherwise forward to Claims Analyst 2 Oversee and provide secondary review of pending cases and Medical Records ordered by Claims Analyst 1 for appropriate processing; Process refunds and letters of dual coverage (when applicable); Must be knowledgeable in CPT-4, ICD-9 and be familiar with medical terminology; Identify process improvement opportunities within the claim department and recommend system enhancements Handles any additional responsibility which may be assigned Technical Skills/Knowledge Health claims processing Basic to intermediate math Medical terminology; ICD-9 & ICD-10 MS Office Ability to work independently or within a team Time management Written and verbal communication Attention to detail Must be able to demonstrate sound decision-making Must be local to Tampa area and work out of the Tampa office Job Type: Full-time Experience: claims or claims processing, managing: 3 years (Required) Work authorization: United States (Required) Job Type: Full-time Pay: $60,000.00 - $80,000.00 per year Benefits: Disability insurance Schedule: 8 hour shift Day shift Monday to Friday Ability to commute/relocate: Tampa, FL 33618: Reliably commute or planning to relocate before starting work (Required) Experience: Medical billing: 5 years (Required) Management: 5 years (Required) Work Location: In person