Clinical Review Supervisor

CorVel Corporation; Fort Worth (TX); Remote; USD 74,000 - 115,000; Full time

Job summary

Join a forward-thinking company as a DRG Clinical Audit Supervisor, where you will lead a team in validating medical records and ensuring compliance with coding regulations. This remote role offers the opportunity to leverage your expertise in ICD-10 coding and DRG auditing while fostering relationships within a collaborative environment. You will be responsible for supervising daily activities, conducting audits, and supporting clinical review processes. With a commitment to accuracy and transparency, this innovative firm provides a supportive culture, comprehensive benefits, and opportunities for career growth. If you are passionate about clinical expertise and making a meaningful impact, this position is perfect for you.

Qualifications

• Experience in DRG auditing with knowledge of ICD-10 coding guidelines.
• Strong communication skills and ability to work independently.
• Supervisory experience managing clinical auditors.

Responsibilities

• Supervise daily activities of DRG Clinical Auditors.
• Complete DRG audits and ensure integrity of diagnosis codes.
• Build relationships internally and externally.

Skills

ICD-10-CM and PCS coding

DRG coding

Payer rules and regulations

Claims denials and appeals

Communication skills

Problem solving

Critical thinking

HIPAA Privacy and Security Rules

Microsoft Office Suite proficiency

Education

N. / L.V.N.

CCS or CIC certification

3-5 years of inpatient / DRG auditing experience

2 years of supervisory experience

Tools

Microsoft Windows

Microsoft Outlook

Microsoft Word

Microsoft PowerPoint

Internet Explorer

Job description

The Diagnostic Related Groups (DRG) Clinical Audit Supervisor is responsible for performing DRG validation (clinical / coding) reviews of medical records and/or other documentation to determine correct DRG / coding that is clinically supported, as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical review forms, accurately documenting findings and non-findings, and providing clinical / policy / regulatory support for the determination.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES :

1. Supervise all daily activities of the DRG Clinical Auditors.
2. Demonstrate knowledge of ICD-10-CM and PCS codes, DRG coding, and understanding of payer rules and regulations, including Medicare and Medicaid, with the ability to work independently with minimal supervision and demonstrate initiative.
3. Complete DRG audits as needed.
4. Ensure the integrity of diagnosis and procedure codes verified by clinical review nurses for inpatient records and documentation received with claims.
5. Possess strong oral and written communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules.
6. Experience with claims denials and appeals.
7. Hold DRG Clinical Auditors accountable to quotas and error/accuracy rates.
8. Maintain working knowledge of HIPAA Privacy and Security Rules.
9. Ability to multi-task, assist with team coverage, and provide support when needed.
10. Build relationships both internally and externally.
11. Proficiency in basic computer skills and typing, including Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc.

KNOWLEDGE & SKILLS :

1. Problem solving and critical thinking skills.
2. Minimal typing experience required.
3. Effective communication skills, both verbal and written.
4. Ability to work independently and as part of a team.
5. Ability to work in a fast-paced, production environment.
6. Proficiency in Microsoft Office Suite.

EDUCATION & EXPERIENCE :

1. N. / L.V.N. preferred.
2. CCS or CIC certification required, with DRG auditing experience in ICD-10-CM and ICD-10 PCS.
3. Proficient in Medicare, CMS guidelines, and ICD-10 coding guidelines.
4. Minimum of 3-5 years of inpatient / DRG auditing experience in a hospital or payer setting.
5. At least 2 years of supervisory experience managing clinical auditors.

PAY RANGE :

CorVel offers a market-based salary approach. Pay rates may vary depending on location, experience, and other factors. The range is $74,421.00 – $114,904.00.

Details about benefits, roles, and company culture are available on the CorVel Careers website.

ABOUT CERIS :

CERIS, a division of CorVel Corporation, is a Great Place to Work-certified company committed to accuracy, transparency, and supporting our partners with clinical expertise and cost containment solutions. We offer comprehensive benefits and career growth opportunities. We are an Equal Opportunity Employer, drug-free workplace, and compliant with ADA regulations.