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The Itemization Review Supervisor will maintain a positive team building approach with emphasis on reporting, leadership and professional communication with all CERIS departments.   

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Maintain all data and analytics information to make critical decisions and accurate results
• Maintain all appeals from all clients as required
• Knowledge of and understanding all departmental policies and procedures as they relate to Itemization Review   
• Advance knowledge of Client Payment Policy for reviews
• Knowledge of Quality Control processes as needed
• Fully understands process of assigning files and assessing nurse’s queues continually
• Fully understands the priority of all claims daily
• Maintains monthly matrix reporting
• Knowledge of CERiS systems and Data Base informatics
• Maintain teams with minimum assistance from manager
• Create a team by promoting a positive work environment
• Additional duties/responsibilities as assigned by manager
• Comply with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (“IIPP”), as well as, maintain HIPAA compliance

KNOWLEDGE & SKILLS:

• Advance organizational, strategic and critical thinking skills
• Effective and professional communication skills
• Ability to handle stressful situations and adapt accordingly
• Demonstrated outstanding leadership, problem solving, and analytical skills
• Ability to think and work independently
• Proficient in scheduling monthly team meetings with emphasis on education
• Proficient in MedCheck, MedCheck Select, CareMC, Tableau, UltiPro, Department Employee Handbook Policy and Procedures, Microsoft Office Suite, Excel, Outlook, and Skype for Business

EDUCATION & EXPERIENCE:

• Must maintain current licensure as a Registered Nurse in the state of employment
• Must have a minimum of 5 years’ experience in the O.R., ICU, or E.R. as an R.N.
• Must have a minimum of 3 years’ experience in LIBR. Preferred but not mandatory
• Must have 3 years or Hospital Supervisor/Manager experience
• Associate Degree in Nursing or higher
• Experience in medical bill auditing, preferred but not mandatory
• Knowledge of ICD-10, DRG and coding required but not mandatory

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:  $70,276 – $116,942

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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