Team Leader Medical Review at Fargo

Job Description

Team Leader Medical ReviewPosition Objective

To facilitate and guide staff, to provide them with the tools and skills and guidance to become responsible for their workloads and their teammates. To influence the direction of Medicare in meeting NAS goals. To ensure staff members meet and exceed standards in coordinating claims review workloads for a multiple state contractor while operating within the Medicare and Corporate budgets. This position will fulfill the responsibilities related to Medical Review. This position will focus on managing the reviews of medical claims for Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) used in the home.

Knowledge

• Knowledge of management theories and practices
• Knowledge of Medicare Rules and Regulations for Coverage and payment of Durable Medical Equipment
• Basic Budget knowledge
• Problem Solving Methodologies
• Project Management
• Understanding of Utilization Review, pre and post pay claims review

Abilities

• Strong PC skills; ability to develop spreadsheets, reports and graphs; flow charts and documents.
• Strong oral and written communication skills.
• Demonstrate leadership skills.(i.e. facilitate a group)
• Strong interpersonal relationship skills.
• Promote team building to maintain a productive and conducive working environment.
• Manage claims inventories.
• Ability to research, evaluate, analyze, resolve, implement, and present solutions and process improvements.
• Create and conduct presentations.
• Manage and facilitate a large group of people.
• Analyze and modify budgets as necessary and operate within approved budget.
• Occasional travel

Job Requirements

Team Leader Medical ReviewEducation and/or Experience

• Bachelors Degree in Nursing with an active Registered Nurse License required
• A minimum of 3 years of nursing experience
• Durable Medical Equipment Experience preferred
• Clinical background in medical/utilization review and/or rehab a plus

Equal Employment Opportunity

An Equal Opportunity/Affirmative Action Employer

Contact
Primary Employment Representative: Jessica Lee
Phone Number: (701) 277-5196
Email: [Click Here to Email Your Resum]


Country: USA, State: North Dakota, City: Fargo, Company: Blue Cross Blue Shield of North Dakota.