Zelis Healthcare
Sr. Supervisor, Clinical Chart Review
Zelis Healthcare, Atlanta, Georgia, United States, 30383
Overview
Position Overview The Sr. Supervisor, Clinical Chart Review is focused on supervising a team of Clinicians performing clinical reviews of facility claims, including UB's, Itemized Bills and medical records, to verify billing accuracy and clinical appropriateness. The Supervisor will be responsible for monitoring the Clinical Reviewer's performance to ensure savings are maximized and captured timely through proper claim handling. Effective and proven leadership experience is required as recommendations to the Nurse Reviewers regarding their claim management are required. This role provides team and operational support to the Manager, Clinical Chart Review, Sr. Level Clinicians and Operations Analysts as directed by Sr. leadership. What you will do
Direct supervision of a team of Clinical Reviewers Accountable for day-to-day business operations performed by the team Monitor the clinical team's work output and queues for timely and proper management of claims Ensure client turnaround times and specific processing guidelines are followed consistently Assess, track and report any delays in claim review or processing to the Manager, Clinical Chart Review Make recommendations to the Manager for process improvement and follow through for proper execution Perform quarterly and as needed Quality Assurance and complete bi-annual assessment of Nurse Reviewer performance; report results to the Manager Continuous assessment of results at the individual clinician level and make recommendations/changes to enhance outcomes Demonstrate understanding of provider billing nuances and service type trends to drive new ideas and recommend new approaches to the Clinical Chart Review team Evaluate current concepts and make recommendations to the CCR Manager to enhance "smart screening" or other workflows that increase efficiencies for the team Ensure all team members are executing the Standard Operating Procedures at all times Collaborate with other members of the Expert Claims Review team as needed Partner with Manager and/or Sr. level team members for research of new concepts; facilitate adjustment of workflows to accommodate new concepts as needed Provide regular support to the Manager, Clinical Chart Review team as needed or directed Maintain awareness of and ensure adherence to Zelis standards regarding privacy at all times What you will bring
Current RN/LPN license Demonstrated leadership experience in an advisory role with management of direct reports Advanced competency in medical claim review and payment integrity preferred Ability to analyze and convert data to Excel format and report trends Proficiency in training techniques to convey subject matter expertise and scale staff to maximize savings and revenue Ability to manage day-to-day operations with minimal supervision and pivot to meet priorities Professional manner and confidentiality of administrative matters and files Ability to manage and prioritize multiple tasks and adapt to departmental needs Ability to work under pressure and meet deadlines Effective communication with others, including providing concise feedback Excellent organizational skills to prioritize responsibilities and complete work timely Computer proficiency with internal systems, EncoderPro, Micromedex, Milliman Care Guidelines, MS Office Suite, PowerPoint and other audit software/tools Note:
Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility
We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employees' work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range
$86,000.00 - $115,000.00 We are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers experience, education, qualifications, and job-related and industry-related knowledge and skills. Base pay is one part of our Total Rewards package, which may include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a comprehensive benefits package, including 401k with employer match, flexible paid time off, holidays, parental leave, life and disability insurance, and medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com. Disclaimer
We are an equal opportunity employer , and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. All personnel may be required to perform duties outside of their normal responsibilities from time to time. #J-18808-Ljbffr
Position Overview The Sr. Supervisor, Clinical Chart Review is focused on supervising a team of Clinicians performing clinical reviews of facility claims, including UB's, Itemized Bills and medical records, to verify billing accuracy and clinical appropriateness. The Supervisor will be responsible for monitoring the Clinical Reviewer's performance to ensure savings are maximized and captured timely through proper claim handling. Effective and proven leadership experience is required as recommendations to the Nurse Reviewers regarding their claim management are required. This role provides team and operational support to the Manager, Clinical Chart Review, Sr. Level Clinicians and Operations Analysts as directed by Sr. leadership. What you will do
Direct supervision of a team of Clinical Reviewers Accountable for day-to-day business operations performed by the team Monitor the clinical team's work output and queues for timely and proper management of claims Ensure client turnaround times and specific processing guidelines are followed consistently Assess, track and report any delays in claim review or processing to the Manager, Clinical Chart Review Make recommendations to the Manager for process improvement and follow through for proper execution Perform quarterly and as needed Quality Assurance and complete bi-annual assessment of Nurse Reviewer performance; report results to the Manager Continuous assessment of results at the individual clinician level and make recommendations/changes to enhance outcomes Demonstrate understanding of provider billing nuances and service type trends to drive new ideas and recommend new approaches to the Clinical Chart Review team Evaluate current concepts and make recommendations to the CCR Manager to enhance "smart screening" or other workflows that increase efficiencies for the team Ensure all team members are executing the Standard Operating Procedures at all times Collaborate with other members of the Expert Claims Review team as needed Partner with Manager and/or Sr. level team members for research of new concepts; facilitate adjustment of workflows to accommodate new concepts as needed Provide regular support to the Manager, Clinical Chart Review team as needed or directed Maintain awareness of and ensure adherence to Zelis standards regarding privacy at all times What you will bring
Current RN/LPN license Demonstrated leadership experience in an advisory role with management of direct reports Advanced competency in medical claim review and payment integrity preferred Ability to analyze and convert data to Excel format and report trends Proficiency in training techniques to convey subject matter expertise and scale staff to maximize savings and revenue Ability to manage day-to-day operations with minimal supervision and pivot to meet priorities Professional manner and confidentiality of administrative matters and files Ability to manage and prioritize multiple tasks and adapt to departmental needs Ability to work under pressure and meet deadlines Effective communication with others, including providing concise feedback Excellent organizational skills to prioritize responsibilities and complete work timely Computer proficiency with internal systems, EncoderPro, Micromedex, Milliman Care Guidelines, MS Office Suite, PowerPoint and other audit software/tools Note:
Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility
We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employees' work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range
$86,000.00 - $115,000.00 We are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers experience, education, qualifications, and job-related and industry-related knowledge and skills. Base pay is one part of our Total Rewards package, which may include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a comprehensive benefits package, including 401k with employer match, flexible paid time off, holidays, parental leave, life and disability insurance, and medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com. Disclaimer
We are an equal opportunity employer , and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. All personnel may be required to perform duties outside of their normal responsibilities from time to time. #J-18808-Ljbffr