Job Role Description

Medical > Medical Claims Manager

Salary National Average

Low Medium High
46340.0000 58420.0000 73570.0000

Change from Previous Year:

+4%

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Candidate Supply: 23 Job Openings: 256

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Short Description:

Plan, organize and direct a medical claims unit. Monitor billing activities, performance management, production standards and quality of results. Analyze data for bill presentation based on technical and compliance requirements and reviews claims for quality and compliance. Prepare, or supervise the preparation of, and analysis of pre-billing and pre-closing processes and bill presentation to ensure quality, accuracy, and compliance with governmental regulations.

Duties / Responsibilities:

  • Protect the security of medical records to ensure that confidentiality is maintained.
  • Review records for completeness, accuracy, and compliance with regulations.
  • Retrieve patient medical records for physicians, technicians, or other medical personnel.
  • Release information to persons or agencies according to regulations.
  • Plan, develop, maintain, or operate a variety of health record indexes or storage and retrieval systems to collect, classify, store, or analyze information.
  • Enter data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment into computer.
  • Compile and maintain patients' medical records to document condition and treatment and to provide data for research or cost control and care improvement efforts.
  • Process and prepare business or government forms.
  • Process patient admission or discharge documents.
  • Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.

Skills / Requirements / Qualifications

  • Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Reading Comprehension — Understanding written sentences and paragraphs in work related documents.
  • Speaking — Talking to others to convey information effectively.
  • Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Monitoring — Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
  • Time Management — Managing one's own time and the time of others.

Job Zones

  • Title: Job Zone Two: Some Preparation Needed
  • Education: These occupations usually require a high school diploma.
  • Related Experience: Some previous work-related skill, knowledge, or experience is usually needed. For example, a teller would benefit from experience working directly with the public.
  • Job Training: Employees in these occupations need anywhere from a few months to one year of working with experienced employees. A recognized apprenticeship program may be associated with these occupations.
  • Job Zone Examples: These occupations often involve using your knowledge and skills to help others. Examples include sheet metal workers, forest fire fighters, customer service representatives, physical therapist aides, salespersons (retail), and tellers.
  • Specific Vocational Preparation in years: (4.0 to < 6.0)

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