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
Maintain HIPAA/patient confidentiality
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 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
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.
Pay Range: $92,673 – $143,587
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.
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