Itemization Bill Review Supervisor

CorVel Corporation; Fort Worth (TX); Hybrid; USD 90,000 - 125,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

Flexible Spending Account Options

Life Insurance

Accident Insurance

Critical Illness Insurance

Pre-paid Legal Insurance

Parking and Transit FSA accounts

401K

ROTH 401K

paid time off

Job summary

CorVel Corporation’s CERIS division seeks an Itemization Review Supervisor to lead a remote team with focus on reporting, leadership and professional communication across CERIS departments.

The role requires RN licensure in the employment state, 5+ years in the OR/ICU/ER, 3+ years supervising, and experience in medical billing and coding. A comprehensive benefits package and ACE-IT culture are offered.

Qualifications

• Must maintain current RN licensure in the state of employment.
• Minimum 5 years’ experience in OR/ICU/ER as an RN.
• Minimum 3 years LIBR experience preferred but not mandatory.
• 3 years Hospital Supervisor/Manager experience required.
• Associate Degree in Nursing or higher.
• Experience in medical bill auditing is preferred.
• Knowledge of ICD-10, DRG and coding is advantageous.

Responsibilities

• Maintain data and analytics information to support decisions.
• Maintain all appeals from all clients as required.
• Understand departmental policies relevant to Itemization Review.
• Advance knowledge of Client Payment Policy for reviews.
• Understand Quality Control processes as needed.
• Understand file assignment and nurse queues continuously.
• Manage daily claim priorities and keep the team aligned.
• Maintain monthly matrix reporting.
• Know CERiS systems and data base informatics.
• Lead a team with minimal manager assistance.
• Create a positive team environment and culture.
• Handle additional duties as assigned by manager.
• Ensure compliance with IIPP and HIPAA requirements.

Skills

Organizational skills

Strategic thinking

Critical thinking

Professional communication

Leadership

Problem solving

Analytical skills

Independent work

Scheduling meetings

Education

Associate Degree in Nursing or higher

RN license in the employment state

Tools

MedCheck

MedCheck Select

CareMC

Tableau

UltiPro

Microsoft Office Suite

Excel

Outlook

Skype for Business

Job description

The Itemization Review Supervisor will maintain a positive team building approach with emphasis on reporting, leadership and professional communication with all CERIS departments.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Maintain all data and analytics information to make critical decisions and accurate results
• Maintain all appeals from all clients as required
• Knowledge of and understanding all departmental policies and procedures as they relate to Itemization Review
• Advance knowledge of Client Payment Policy for reviews
• Knowledge of Quality Control processes as needed
• Fully understands process of assigning files and assessing nurse’s queues continually
• Fully understands the priority of all claims daily
• Maintains monthly matrix reporting
• Knowledge of CERiS systems and Data Base informatics
• Maintain teams with minimum assistance from manager
• Create a team by promoting a positive work environment
• Additional duties/responsibilities as assigned by manager
• Comply with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (“IIPP”), as well as, maintain HIPAA compliance

KNOWLEDGE & SKILLS:

• Advance organizational, strategic and critical thinking skills
• Effective and professional communication skills
• Ability to handle stressful situations and adapt accordingly
• Demonstrated outstanding leadership, problem solving, and analytical skills
• Ability to think and work independently
• Proficient in scheduling monthly team meetings with emphasis on education
• Proficient in MedCheck, MedCheck Select, CareMC, Tableau, UltiPro, Department Employee Handbook Policy and Procedures, Microsoft Office Suite, Excel, Outlook, and Skype for Business

EDUCATION & EXPERIENCE:

• Must maintain current licensure as a Registered Nurse in the state of employment
• Must have a minimum of 5 years’ experience in the O.R., ICU, or E.R. as an R.N.
• Must have a minimum of 3 years’ experience in LIBR. Preferred but not mandatory
• Must have 3 years or Hospital Supervisor/Manager experience
• Associate Degree in Nursing or higher
• Experience in medical bill auditing, preferred but not mandatory
• Knowledge of ICD-10, DRG and coding required but not mandatory

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CERIS:

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees.

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.