The Diagnostic Related Groups (DRG) Clinical 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.
This is a remote position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
Supervises all daily activities of the DRG Clinical Auditors
Demonstrated knowledge of, ICD-10-CM and PCS codes, and DRG coding,
understanding of payer rules and regulations, including Medicare and Medicaid
with the ability to work independently with minimal supervision and
demonstrate initiative
Completes DRG audits as needed
Responsible for the overall integrity of the quality of diagnosis and
procedure codes verified by the clinical review nurses, for inpatient records
and documentation received with the accompanied claim
Responsible for holding the DRG Clinical Auditors to the quota and
error/accuracy rate
Assists with team coverage and provide support when needed
May be required to travel overnight and attend meetings or training
Additional duties as assigned
KNOWLEDGE & SKILLS:
Clinical knowledge of medical necessity rules
Working knowledge of HIPAA Privacy and Security Rules
Ability to build strong working relationships both internally and externally
Strong attention to detail
Must possess problem solving, critical thinking skills
Minimal typing experience
Excellent written and verbal communication skills
Ability to think and work independently, while working in an overall team
environment
Ability to work in a fast paced/production environment
Proficient in Microsoft Office applications
EDUCATION & EXPERIENCE:
N./L.V.N. preferred
CCS or CIC 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 a hospital
setting and/or payer setting
A minimum of 2 years of supervisory experience dealing with clinical auditors
is required
Experience with claims denials and appeals required
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.
Pay Range: $77,960 – $120,368
A list of our benefit offerings can be found on our CorVel website: CorVel
Careers | Opportunities in Risk Management
[https://www.corvel.com/company/careers/]
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.
#LI-Remote