Medical Bill Review Manager
MAXIMUS, Inc.
 Pittsford, NY

Since 1975, MAXIMUS has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. MAXIMUS delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, MAXIMUS is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom.

Job Description Summary

Essential Job Duties:•Responsible for identifying and resolving issues, problems, and concerns with employees and client•Provide direct guidance to company and contractor employees by supervising, motivating, and monitoring staff to ensure compliance with bill review procedures and standards•Provide assistance and updates to staff regarding the programs, policies, and procedures as well as assist teams when necessary in coordination of case processing and workload adjustment•Ensure all staff are complying with company and project policies•Develop unit goals and objectives, and monitor achievement of these goals•Oversee workflow management of approved processes•Ensure staff meets production and quality standards by communicating job expectations and planning, monitoring, and appraising job results, as well as initiating appropriate and necessary disciplinary actions•Maintain clear and effective communication with staff and management•Utilize control systems and procedures to maximize productivity•Complete special projects by organizing and coordinating information and requirements planning, arranging and meeting schedules; and monitoring results•Make recommendations for improving policies and procedures•Be a subject matter expert to accurately respond to process inquires and to recognize when documentation requires updating•Administer performance management processes to include developing and implementing training plans, monitoring quality and productivity, administering corrective/disciplinary action when necessary, and administering the performance evaluation process•Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures•Ensure the confidentiality and security of all information and maintain updated knowledge of Client requirements•Interact with different levels of external and internal customers•Consult with Legal Counsel, Physician Reviewers, Medical Directors, and Project Directors as necessary•Performs other duties as may be assigned by management.Education and Experience Requirements:•Bachelor's degree from an accredited college or university required•At least two (2) to four (4) years of management or supervisory experience•NY Worker's Compensation Medical Treatment Guidelines knowledge preferred•Strong verbal and written communication skills•Ability to review and interpret policy, law, provisions, and financial data•Strong analytical skills•General health care insurance knowledge•Excellent attention to detail•Logical thought process•Ability to meet department audit quality standards•Excellent organizational skills•Ability to work well with others•Ability to make decisions and easily adapt to change•Familiarity with PC and software programs•Ability to work with little supervision

Essential Duties and Responsibilities: - Manage teams and staff assigned. - Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures. - Perform other duties as assigned by management. Minimum Requirements: - Manage, perhaps through subordinate supervisors, the coordination of the activities of a section or department with responsibility for results, including costs, methods and staffing. - In some instances this manager may be responsible for a functional area and not have any subordinate employees. - Work on issues of diverse scope where analysis of situation or data requires evaluation of a variety of factors, including an understanding of current business trends. - Follow processes and operational policies in selecting methods and techniques for obtaining solutions. - Act as advisor to subordinate(s) to meet schedules and/or resolve problems. - Develop and administer schedules, performance requirements; may have budget responsibilities. - Frequent interaction with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company. - Often must lead a cooperative effort among members of a project team. - Receive assignments in the form of objectives and determine how to use resources to meet schedules and goals. - Provide guidance to subordinates within the latitude of established company policies. - Recommend changes to policies and establish procedures that affect immediate organization(s).

EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.