Medical Claims Review Manager jobs in Pennsylvania

Description:
Could you be our next Clinical Reimbursement Manager-Utilization Review at HomeCare & Hospice?

Why work as a Clinical Reimbursement Manager with Main Line Health?

• Make an Impact! Your leadership makes a difference! Our Clinical Reimbursement Manager-UR reviews all clinical assessment (OASIS) and plans visit based on the care needs of the client and the reimbursement to be received by the agency for providing this care. You will be responsible for overseeing and evaluating the services provided to home health clients to maximize clinical outcomes, financial profitability, and regulatory compliance. You will use your expertise in making these decisions in collaboration with the payor as needed by reviewing the profit and loss of each client taken under care and the ability of the client/caregiver to support care in the home. You will also ensure the proper ICD-10 coding, oversee the progress of the client during the home health admission, monitor care events that may trigger a change in care needs, manage an average active caseload of 100-150 clients (1500 clients annually) and monitor the activity of 200 clinical staff.
  
  
• Join the Team! Like our patients, the Main Line Health Family encompasses a wide range of backgrounds and abilities. Just as each of our patients requires a personalized care plan, each of our employees, physicians, and volunteers, bring distinctive talents to Main Line Health. Regardless of our unique design, we all share a purpose: providing superior service and care.
  
  
• Position-Specific Benefits include: We offer a number of employee discounts to various activities, services, and vendors... And employee parking is always free!
  
  

Position: Clinical Reimbursement Manager-UR
Shift: Every other weekend day shift

Experience:
1. Three to five year’s clinical experience with at least two years home care experience required.
2. Basic computer skills required, knowledge of home health information system a plus
3. Knowledge of Medicare regulations pertaining to Home Health, expertise in Home
4. Health Coding preferred.

Education:
1. Graduate of an accredited School of Nursing required.
2. Associate’s degree required.
3. Bachelor’s degree preferred.

Licensures/Certifications:
1. Current licensure in the Commonwealth of Pennsylvania as a Registered Nurse required.
2. Valid driver’s license and insured automobile required.
3. Home Care Coding Specialist Certification as described above required.