Medical Claims Review Supervisor

Description Charlie Gilmur with Robert Half is in search of a Medical Claims Review Supervisor to join our team in MILWAUKIE, Oregon. This role is primarily focused on supervising the claims review team in the healthcare industry. The successful candidate will be responsible for overseeing the claims review process, ensuring timely submission of all pharmacy claims, and developing strategies to reduce rejected claims.Responsibilities: Provide general oversight of the claims review team to ensure efficient operations Implement and execute departmental policies and procedures to maintain high service standards Manage the Medicaid and Medicare Part D plan formulary Design, plan, and organize training programs for new team members Develop procedures to reduce the number of denied claims Ensure timely submission of all pharmacy claims Handle other duties as assigned by the manager Use analytical skills to identify areas of opportunity and engage in continuous improvement Utilize medical terminology knowledge to review and process medical claims Leverage strong leadership skills to make independent decisions regarding management, planning, scheduling, and assignment of work.Please contact Charlie Gilmur with Robert Half to review this position. Job Order: 03600-0013034726Requirements In-depth knowledge of 'About Time' software Proficiency in medical claims processing and understanding of related regulatory standards Experience in medical billing, preferably in a hospital or clinic setting Understanding of pharmacy claim procedures and related legal guidelines Prior experience in a supervisory role, demonstrating leadership and team management skills Excellent communication and interpersonal skills to effectively interact with team members and other departments Strong analytical and problem-solving skills to handle claim disputes and irregularities Ability to work under pressure and meet tight deadlines Proficient in Microsoft Office Suite, especially Excel for data management and analysis Familiarity with health insurance policies and procedures Knowledge of medical terminology and coding systems High attention to detail and accuracy in handling and reviewing medical claims Ability to maintain confidentiality and adhere to HIPAA regulations Bachelor's degree in Healthcare Administration, Business Management, or related field is preferred. Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .