Payment Integrity Supervisor

The Payment Integrity Supervisor is responsible for the daily activities of payment integrity team related to quality assurance and provider appeals. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and appeals. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers.This is a remote position.Essential Functions And ResponsibilitiesSupervises all daily activities of payment integrity team related to quality assurance and provider appealsAbility to assist team with problem-solving, payer policy and clinical questions regarding audits performed by CERISAbility to review and apply clinical knowledge along with payer policy to charges submitted on UB's, itemized bills and medical records to determine accuracy of charges billedResponsible for ensuring new employees are oriented to the organization, its policies, facilities, etc. Supervisors should also provide ongoing guidance to employees, often in the forms of ongoing career coaching, counseling and performance appraisalEnsures appeals and grievances are resolved in a timely mannerDemonstrate ability to manage multiple projects, set priorities and manage to committed scheduleKeeps manager informed of any issues that arise with appeals, quality assurance and/or team that cannot be resolvedAct as a point of contact for internal departments to answer and resolve any questions related to appeals and quality assurancePrepare and distribute reporting materials and team training presentations as directed by the managerMaintain HIPAA privacy and security protocolsPerform audits and/or appeal review as necessaryAdditional duties as assignedKnowledge & SkillsStrong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)Strong understanding of healthcare claims reimbursementProficient in Microsoft Office including Excel and WordStrong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovativeExcellent written and verbal communication skillsAbility to think and work independently, while working in an overall team environmentStrong attention to detail and ability to deliver results in a fast paced and dynamic environmentEducation/ExperienceAssociate Degree in Nursing or higher required as applicable. BSN preferredMust maintain current licensure as a Registered Nurse in the state of employment as applicableMust maintain current coding certification as applicableCompletes required CEUs to maintain Registered Nurse license and/or coding certification as applicableDemonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable5+ years experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics preferred for non-DRG auditsAs applicable for DRG rolesCCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10-PCSProficiency in both MS and APR DRG reimbursement methodsDemonstrated knowledge and understanding of clinical criteria documentation requirements used to successful substantiate code assignments.3+ years of relevant experience or equivalent combination of education and work experience2+ years medical claims auditing of inpatient, outpatient and ASC claims preferred.2+ years of supervisory or management experiencePay RangeCorVel 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.Pay Range: $77,960 – $120,368A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk ManagementIn 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 CerisCERIS, 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.J-18808-Ljbffr