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Claims Review Management Nurse (4875)

Claims Review Mgmt | Harrisburg, PA | Contract

Job Description

Claims Review Management Nurse
Work Location: Harrisburg, PA


Job Summary/Description

Searching for a Claims Review Management Nurse to provide managerial leadership and oversight to project and processes. In this role, the Claims Review Management Nurse will be assigned to management workgroups and project teams. The assignments will consist of a combination of on-going process responsibilities, standing workgroup participation and time-limited projects related to the management and operations of all aspects of the Pennsylvania Medicaid program. If you meet the qualifications, please apply and a Recruiter will reach out to you and answer any questions you may have.


Job Duties/Responsibilities/Functions(including but not limited to)

• Evaluation and implementation of system enhancements for provider enrollment, provider inquiry and medical review

• Evaluation of current processes and implementation of recommended process improvement

• Consult with senior staff to outline major operational issues and develop resolutions based on sound data analysis

• Act as liaison between the Department of Human Services and external stakeholders (individuals and/or groups)

• Assist in the development of in-house training programs related to claims review and processing

• Assist in determining if any changes should be made to criteria or regulations to better serve clients

• Learn and be a resource for how claims process through the payment system

• Assist with coding and procedure code groupings

• Provide operational input for claims processing decisions

• Interface with Providers experiencing billing /claims problems

• Perform other related duties as assigned by the managerial staff


Minimum Qualifications

• Possess an active Pennsylvania Registered Nurse license - Required

• Knowledge of Utilization Review Processes - Required

• Basic Computer Skills - Required

• Knowledge of Microsoft Excel, Word and Outlook - Required

• Possess a documented work history of five (5) or more years of experience with claims review/processing

• Knowledge of Medical Assistance - Desired

• Knowledge of Medical Coding - Highly Desired


About InGenesis

InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.


EEOC Statement

We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.