Clinical Review Supervisor

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

Job summary

A leading company is seeking a Clinical Review Supervisor to oversee DRG validation reviews and ensure compliance with coding regulations. This remote role requires strong communication skills, attention to detail, and experience in DRG auditing. The ideal candidate will have supervisory experience and a commitment to quality in healthcare payments.

Qualifications

• Minimum of 3-5 years of inpatient/DRG auditing experience.
• At least 2 years of supervisory experience with clinical auditors.

Responsibilities

• Supervises daily activities of the DRG Clinical Auditors.
• Ensures integrity and quality of diagnosis and procedure codes.
• Completes DRG audits as needed.

Skills

Attention to Detail

Problem Solving

Communication

Education

CCS or CIC certification

N./L.V.N. preferred

Tools

Microsoft Office Suite

Job description

Join to apply for the Clinical Review Supervisor role at CERIS.

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.

Job Details

This is a remote position.

Essential Functions & Responsibilities

• Supervises all daily activities of the DRG Clinical Auditors.
• Demonstrates knowledge of ICD-10-CM and PCS codes, DRG coding, payer rules, and regulations, including Medicare and Medicaid. Able to work independently with minimal supervision and demonstrate initiative.
• Completes DRG audits as needed.
• Ensures the integrity and quality of diagnosis and procedure codes verified by clinical review nurses for inpatient records and documentation received with claims.
• Possesses strong oral and written communication skills, clinical knowledge of disease processes, and understanding of medical necessity rules.
• Experience with claims denials and appeals.
• Holds DRG Clinical Auditors accountable for quotas and error/accuracy rates.
• Maintains working knowledge of HIPAA Privacy and Security Rules.
• Ability to multi-task, assist with team coverage, and provide support when needed.
• Builds relationships internally and externally.
• Proficient in basic computer skills and typing, including Microsoft Windows, Outlook, Word, PowerPoint, Internet Explorer, etc.

Knowledge & Skills

• Extreme attention to detail.
• Problem solving and critical thinking skills.
• Effective and professional communication skills, both verbal and written.
• Ability to work independently and in a team environment.
• Ability to work in a fast-paced/production environment.
• Proficient in Microsoft Office Suite.

Education & Experience

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

Pay Range

Range: $74,421.00 – $114,904.00. Compensation is market-based and may vary depending on location, experience, and qualifications.

About CERIS

CERIS, a division of CorVel Corporation, offers clinical expertise and cost containment solutions, emphasizing accuracy and transparency in healthcare payments. We are committed to our core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).