Responsible for planning, leading, and coordinating multiple teams of nurse auditors and associated billing staff in a fast paced, productivity-based environment. This role oversees auditors performing varying types of medical bill audits including, but not limited to, medical record audits, hospice, implant, and outpatient or ancillary facility claims. This team also performs facility onsite and remote hospital bill audits. Must be willing to travel for onsite facility audits and other meetings as needed.
This is a remote position.
Essential Functions & Responsibilities
- Utilize nursing education, experience, and industry best practices to lead a team of registered nurses to plan, execute and deliver timely and accurate results.
- Assist in the training, professional development, and retention of nurse auditors.
- Ensure accuracy of audits through acquired knowledge of client policies, provider contract information, and other standard guidelines.
- Assist in the development and support of staff to meet and exceed productivity metrics based on CERIS productivity standards and company policy.
- Acts as a point of contact for providers regarding onsite and remote audits.
- Responsible for managing team daily file flow and prioritization of rush files, special projects, client special requests, test files, and other special requests as needed.
- Oversee the scheduling and completion of remote and onsite audits in an efficient and timely manner.
- Responsible for identifying and understanding gaps in workflows to develop potential process improvement plans.
- Research and respond to staff questions and concerns in a timely, professional manner.
- Responsible for human resource matters directly related to direct and indirect staff including, but not limited to, yearly evals, interviewing, hiring, documentation of events or occurrences, coaching, time and attendance, and any additional personnel issues or interventions.
- Responsible for daily, monthly, ad hoc reports and summaries as requested by director of audit or other executive leadership.
- Participate in provider and client calls.
- Ability to research audit issues to make education decisions.
- Additional duties as assigned by director of audit or other executive leadership.
Knowledge & Skills
- Knowledge of hospital billing requirements including UB-04, 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 a team player to manage staff and create a positive team working environment.
- Must be proficient in Microsoft office applications including excel.
- Must have exceptional organizational skills.
Education & Experience
- Associate degree and current RN license in the state of employment. Bachelor’s or Master’s degree in nursing preferred
- 3+ years of experience in healthcare facility charge and billing audit or related experience.
- Previous supervisory/management experience required.
- Additional certifications in nursing, 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: $83,232 – $128,502
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.
