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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 RESPONSIBILITIES:

• Supervises all daily activities of payment integrity team related to quality assurance and provider appeals
• Ability to assist team with problem-solving, payer policy and clinical questions regarding audits performed by CERIS
• Ability 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 billed
• Responsible 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 appraisal
• Ensures appeals and grievances are resolved in a timely manner
• Demonstrate ability to manage multiple projects, set priorities and manage to committed schedule
• Keeps manager informed of any issues that arise with appeals, quality assurance and/or team that cannot be resolved
• Act as a point of contact for internal departments to answer and resolve any questions related to appeals and quality assurance
• Prepare and distribute reporting materials and team training presentations as directed by the manager
• Maintain HIPAA privacy and security protocols
• Perform audits and/or appeal review as necessary
• Additional duties as assigned

KNOWLEDGE & SKILLS:

• Strong understanding of claims processing, ICD-10 Coding, DRG Validation (if applicable)
• Strong understanding of healthcare claims reimbursement
• Proficient in Microsoft Office including Excel and Word
• Strong interpersonal skills and adaptive communication style, complex problem-solving skills, drive for results, innovative
• Excellent written and verbal communication skills
• Ability to think and work independently, while working in an overall team environment
• Strong attention to detail and ability to deliver results in a fast paced and dynamic environment

EDUCATION/EXPERIENCE:

• Associate Degree in Nursing or higher required as applicable. BSN preferred
• Must maintain current licensure as a Registered Nurse in the state of employment as applicable
• Must maintain current coding certification as applicable
• Completes required CEUs to maintain Registered Nurse license and/or coding certification as applicable
• Demonstrated knowledge of CMS guidelines and ICD-10 coding guidelines as applicable
• 5+ 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 audits
  • As applicable for DRG roles
    • CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10-PCS
    • Proficiency in both MS and APR DRG reimbursement methods
    • Demonstrated 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 experience
• 2+ years medical claims auditing of inpatient, outpatient and ASC claims preferred.
• 2+ years of supervisory or management experience

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 

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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