Senior Manager Clinical Audit

CorVel Corporation; Fort Worth, Northern (TX, KY); Hybrid; USD 120,000 - 180,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

401K

Paid time off

Job summary

CorVel Corporation seeks a Senior Manager, Clinical Audit to plan, lead, and coordinate multiple audit teams and billing staff in a fast-paced environment. Remote position with onsite visits as needed; travel required for site visits and meetings.

The role demands critical thinking and data-driven decisions to ensure accurate results. Responsibilities include building remote/onsite teams, implementing performance metrics, HR duties, and KPI tracking to meet client SLAs.

Qualifications

• RN licensure required; state license must be current and unencumbered.
• Bachelor’s or master’s degree in nursing or related healthcare field preferred.
• 5+ years of experience in healthcare billing audit or related field.
• 3+ years of leadership experience required; supervision of teams and staff.
• Additional certifications in nursing, coding, business management and/or medical bill review a plus.

Responsibilities

• Lead teams of auditors and billing staff to plan, execute and deliver results.
• Communicate professionally with clients and internal teams.
• Build and manage remote and onsite teams through hiring and development.
• Implement performance metrics and evaluation systems for team performance.
• Manage HR responsibilities for direct and indirect staff.
• Track KPIs and SLAs; drive process improvements.
• Report departmental metrics to leadership as requested.
• Ensure adherence to turnaround times and SLAs.

Skills

Auditing leadership

Healthcare billing expertise

CPT/HCPCS/ICD-10 knowledge

Critical thinking

Strong communication

Microsoft Excel

Education

Registered Nurse licensure

Bachelor’s or Master’s in nursing/healthcare

Active RN licensure in state of employment

Certifications in nursing, coding, business management or medical bill review

Tools

Microsoft Office

Job description

The Senior Manager, Clinical Audit is responsible for planning, leading, and coordinating multiple teams of auditors and associated billing staff in a fast paced, productivity-based environment to achieve organizational goals. This role oversees auditors performing varying types of medical bill reviews and audits utilizing medical records, itemized bills, and other auditing and coding tools.

The Senior Manager, Clinical Audit, also be required to perform onsite facility visits and must be willing to travel for both site visits and other meetings as needed. In this role, the Senior Manager, Clinical Audit will need to use critical thinking and analytical skills to make knowledge-based decisions in a fast-paced production environment.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Utilize education, experience, and industry best practices to lead teams of auditors to plan, execute and deliver timely and accurate results
• Professional and timely communication with clients, account management and other departments
• Build, lead, and manage remote and/or onsite teams made up of managers, supervisors, and staff through hiring, onboarding, ongoing career development, and a positive team environment
• Work directly with managers and supervisors to implement performance metrics and evaluation systems to assess individual and team performance
• Responsible for all HR related duties for direct and indirect staff
• Responsible for managing and maintaining all KPIs and adherence to SLAs, identifying and resolving problems, preparing, and completing action plans to drive process improvement
• Responsible for tracking and reporting departmental metrics to director or executive leadership as requested
• Responsible for monitoring and compliance with turnaround times and other SLAs as required by our clients
• Responsible for daily, weekly, monthly reviews of various reports, invoices, logs, and expenses
• Acts as a point of contact for both internal and external customers
• Additional duties as assigned

CROSS-FUNCTIONAL LEADERSHIP:

• Partner collaboratively with internal teams across CERIS and CorVel
• Foster a culture of collaboration, professionalism, support, and cooperation
• Provide constructive feedback and coaching to improve performance and achieve department goals
• Promote a culture of integrity, transparency, and accountability
• Promote open, transparent communication across teams to ensure concerns, risks, and challenges are surfaced early and addressed collaboratively
• Foster an environment of mutual respect and trust when engaging with internal partners, clients, and external stakeholders
• Model and reinforce professional conduct, accountability, and integrity in all interactions and decision-making
• Promote inclusivity, professionalism, and cooperation to enhance team cohesion and organizational culture

KNOWLEDGE & SKILLS:

• Knowledge of hospital billing requirements including UB-04, HCFA1500, itemized bills, revenue codes, CPT/HCPCS codes, ICD10 diagnosis and procedure codes
• Knowledge of industry standards for medical bill audit based on national and state policy guidelines including how to research those policies and guidelines
• Ability to write and speak clearly, easily communicating complex ideas
• Ability to interpret and answer complex questions and requestsAbility to think critically and work independently to meet deadlines and complete priorities
• Ability to remain composed in stressful situations and communicate professionally
• Must be proficient in Microsoft Office applications including Excel
• Must have exceptional organizational skills

EDUCATION & EXPERIENCE:

• Registered Nurse licensure required
• Bachelor’s or master’s degree in nursing or related healthcare field preferred
• RNs are required to keep current and unencumbered licensure in the state of employment
• 5+ years of experience in healthcare billing audit or related experience required
• 3+ years previous leadership experience required
• Additional certifications in nursing, coding, business management and/or medical bill review a plus

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 and includes

• 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.