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Supervisor Medical Claim Review

Fortune Staffing Solutions    posted over 5 years ago

FullTime | Staffing Agency | $75,000 | Portland, OR, United States

Minimum criteria:

  • Do you have hospital billing experience
  • Are you active Registered Nurse
  • Do you have management experience


Bring your nursing background, mental acuity, and leadership expertise to this role where you will be accountable for: 
•Supervision of clinical staff performing post-service medical claim review 
•Performance management and staff development, including assigning staff caseloads, monitoring performance metrics for accuracy and timeliness, communicating process changes, and employee coaching. 
•Creation and maintenance of desk procedures to ensure medical payments are appropriate and in alignment with medical policy, contract provisions, proper coding, and compliance 
•Implementation of efficiencies to improve performance and report generation to demonstrate outcomes 
•Acting as a resource for staff and liaising with Medical Directors, Claims, Quality, and other areas of the organization as required

Key Qualifications and Experience: 
•Active, unrestricted RN, PA, or NP License required. Bachelor’s degree in a health related field preferred. 
•3 years previous supervisory or leadership experience in managing teams, leading systems implementations or process improvements 
•Ability to manage teams that work in multiple locations and via telecommuting technology. (Instant Message, phone, web meetings, etc.) 
•Strong background and experience in chart abstraction, medical claim review, or hospital billing and coding. 
•ICD-9, ICD-10, and CPT coding experience is desired. 
•Experience in medical documentation and policy review and analysis 
•Excellent computer skills with the ability to navigate multiple systems simultaneously 
•Strong experience with Microsoft Office Products (Word, Excel, Outlook). Familiar with Electronic Medical Record (EMR) systems preferred 
•Minimum 5 years clinical practice experience. 
•Knowledge of health insurance industry trends and new technology. 
•Excellent written and verbal communication and presentation skills. 
•Demonstrated problem recognition and resolution skills.
Relocation assistance is available for this opportunity.


Must Have

Active, unrestricted RN 
Experience with hospital billing, ICD-9 and CPT coding 
Staff management skills 
Ideal candidate will have strong leadership skills, having managed direct reports across multiple locations. Solid clinical background, active RN and excellent knowledge of hospital billing and coding. Experience in a managed care enviornment preferable

The ideal candidate has worked for these companies:
Premera Blue Cross, Group Health, Kaiser, Providence, Tuality, Good Samaritan, Molina, Lifewise, Aetna, United Health Care, Cigna, other hospitals, or health insurance agencies.

Employer avg response time


  • Relocation Assistance: No
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