Medical Review Audit Supervisor - Clinical RN (Commercial Home Health)

ABOUT PERFORMANT: At Performant, we're focused on helping our clients reputed company their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment reputed company company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most - quality of care and healthier lives for reputed company. If you are seeking an employer who values People, Innovation, reputed company, Fun, and fostering an Ownership Culture - then Performant is the reputed company for you! ABOUT THE OPPORTUNITY: Hiring Range: $78,500 - $93,000 The Medical Review Audit Supervisor - Clinical RN (Commercial Home Health) leverages their nursing background, deep knowledge of clinical review, and experience leading others to manage staff and operational results for a remote team of nurses and other audit roles, performing clinical review audits. The Supervisor will reputed company first-hand experience and knowledge of claims auditing for supporting management with strategy activities such as needs assessments, reputed company planning, and ensuring required staffing levels and productivity & quality standards are being achieved consistently. Key Responsibilities to include:

• Regularly performs limited volume of clinical audits to maintain subject matter expertise, and additionally as needed to support business needs.
• Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects.
• Contributes to the resolution of quality review rebuttals.
• May reputed company appeals review/activity to supplement Appeals team, based upon business need.
• Actively identifies and recommends opportunities for cost savings and improving outcomes that can have a direct impact to the company's profitability.
• Effectively ensures adherence to medical review guidelines and training requirements of staff.
• Supports audit management and reputed company specialists with activities for new concept implementation
• Supports management with needs assessments and reputed company planning
• Monitor and manage inventory of assigned business to ensure timelines are met.
• Use data, reports and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs.
• reputed company and review audit determinations to ensure consistency in decision-making.
• Collaborate with other departments to resolve operational problems.
• Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing levels necessary to reputed company business objectives.
• Provides support as needed to ensure auditors are equipped with tools and resources required to reputed company audits.
• Supervise daily activities of clinical audit staff that may include both salaried exempt and hourly employees.
• Provide audit guidance to medical review staff; identify trends and present solutions.
• Routinely provides production and quality performance-based reputed company reports, coaching, and constructive feedback to staff.
• Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures.
• Collaborates with The People Team for applicable corrective action as applicable.
• Complete and conduct performance reviews for assigned staff.
• Conduct team meetings with direct reports on a regular basis.
• Provide leadership to team members, provide solutions, and resolve conflicts.
• Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee matters.
• Provide reporting and updates to management as required and appropriate for operational and staff activity and results.
• Participates in and contributes to applicable department meetings.
• May participate to client-facing meetings; research and analyze issues; present findings and solutions; and/or provider training.
• May support management with activities to monitor inventory and activity of 3rd party/subcontractors.
• Become subject matter expert for assigned business reputed company(s).
• Maintain reputed company knowledge and changes that reputed company our industry and clients as it pertains to medical practice, technology, regulations, legislation and business trends.
• May support training material/tools and best practices development.
• Identify needs and ensure team receives necessary training.
• Support training activities for new audit staff or provide supplemental training for existing staff as needed.
• Contributes to positive team environment that fosters open communication, sharing of information, reputed company improvement, and optimized business results.
• Receives feedback and adjusts work reputed company for self and team as necessary.
• Leads by example and conducts work in accordance with company policies, government regulations and law.
• reputed company other incidental and reputed company duties as required and assigned to meet business needs.

Knowledge, Skills and Abilities Needed:

• Strong knowledge of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment rules.
• Experience with CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding.
• Proficiency with MCS 1500/UB 04 forms
• Working knowledge of encoder
• Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines, reputed company or InterQual.
• Proven ability to review, analyze, and research medical billing, documentation, and coding issues
• Reimbursement policy and/or claims software analyst experience
• Familiarity with interpreting electronic medical records (EHR)
• Willing and able to reputed company by example, communicate reputed company, take initiative and drive the team to reputed company organizational goals.
• Experience in developing, documenting and implementing process and procedures.
• Experience in inventory management, resource planning and report reputed company.
• reputed company in analyzing information, identifying trends and presenting solutions.
• Understands inventory management objectives, activities, and key drivers in achieving operational goals.
• Demonstrated ability to consistently apply sound judgment and good effective decision making.
• Excellent communication skills, both verbal and written; ability to communicate effectively and professionally at reputed company levels reputed company the organization, both internal external.
• Demonstrated ability to collaborate effectively in a variety of settings and topics.
• Excellent editing and proofreading skills.
• Demonstrated ability to successfully reputed company, reputed company, and motivate a team to high performance; effectively provides constructive feedback and coaching for successful outcomes.
• Ability to independently organization, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively.
• Excellent time management and delivers results balancing multiple priorities.
• Strong analytical skills; synthesizes reputed company or diverse information; collects and researches data; uses experience to compliment data.
• Leverages strong critical thinking, questioning, and listening skills to research and effectively resolve reputed company issues.
• Demonstrated ability to identify areas of opportunity and create efficiencies in workflows and procedures.
• Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions.
• Ability to create documentation outlining findings and/or documenting suggestions.
• Strong general technical skills, including, but not limited to Desktop and MS Office applications (Intermediate reputed company Skills), application reporting tools, and case management system/tools to review and document findings.
• Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools.
• Ability to be flexible and reputed company in a high pace environment with changing priorities.
• Adaptable to applying skills to diverse operational activities to support business needs.
• Self-starter with the ability to work independently in remote setting with minimum supervision and direction in the form of objectives.
• Serves as positive role model, and demonstrates characteristics that align and contribute to a collaborative culture of reputed company improvement and high performing teams.

Required and Preferred Qualifications:

• reputed company active unrestricted Nursing license in good standing required. Not currently sanctioned or excluded from the Medicare program by OIG, is also required.
• Medical coding certification is a plus.
• 3+ years diverse nursing experience providing direct care in an inpatient or outpatient setting.
• 2+ years of performing medical record audits in a provider setting, or in a payer setting for a health insurance company.
• 5+ years in health care claims that demonstrates expertise in ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. Those who have less than 5 years experience may be considered based upon demonstrated skills and/or formal training and other relevant experiences
• 3+ years relevant supervisory or leadership experience in similar business environment, preferred. Experience managing remote staff is a plus.
• Some Supervisory experience may be required for certain Supervisor roles.
• Prior experience in payer edit development, and/or reimbursement policy experience a plus.

reputed company OFFER: Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your reputed company contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. reputed company of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.
• Regularly reads and comprehends information in electronic (computer) or reputed company form (written/printed).
• Regularly sit/reputed company or more hours per day.
• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background reputed company and drug test (applies to reputed company positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.
• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and reputed company reputed company policies and procedures.
• Other requirements may apply.

reputed company employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, reputed company employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and reputed company of Sensitive, Proprietary, Confidential and/or Public data at reputed company times. Violations to Performant's policy reputed company to the Confidentiality or reputed company of data may be subject to disciplinary actions up to and including termination. Performant is committed to the full inclusion of reputed company qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you reputed company a reasonable accommodation is required to fully participate in the job application or interview process, to reputed company the essential functions of the position, and/or to receive reputed company other benefits and privileges of employment, please contact Performant's reputed company to discuss further. Our diversity makes Performant unique and strengthens us as an organization to help us reputed company serve our clients. Performant is committed to creating a diverse environment and is proud to be an equal opportunity employer. reputed company qual... Apply tot his job Apply To this Job