Note: The job is a remote job and is open to candidates in USA. CERIS, a division of CorVel Corporation, provides clinical expertise and cost containment solutions focused on accuracy and transparency in healthcare payments. The Senior Manager, Clinical Audit leads multiple teams conducting medical bill reviews and audits, manages performance and compliance metrics, and coordinates client communication, staffing, and process improvement in a remote, productivity-based environment.
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
- Maintain HIPAA/patient confidentiality
- Additional duties as assigned
- 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
Skills
- 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
- 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 requests
- Ability 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
- Registered Nurse licensure required
- 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
- Bachelor's or master's degree in nursing or related healthcare field preferred
- Additional certifications in nursing, coding, business management and/or medical bill review a plus
Benefits
- This is a remote position.
- 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.
- Career advancement opportunities
Company Overview