Job Description

Job Description

Job Description

Responsible for planning, leading and coordinating a team of registered nurse hospital bill auditors. This team performs on site and remote hospital bill audits.

This a remote role.

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 provider hospital bill audits
• Direct the training, professional development, and retention for the 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 auditors to meet and exceed productivity requirements based on CERiS productivity standards
• Act as a point of contact to answer and resolve auditor issues with the goal of providing excellent customer service and relationship management
• Perform audits as necessary
• Responsible for managing the daily file flow coming into Medical Review while maintaining awareness of potential file flow from other departments to track rush or special files, test files, pilot studies for prospective clients
• Acknowledge and oversight of work assigned, maintain timely communication with Audit Coordinator, schedule and complete audits in an efficient and timely manner
• Research and respond to staff questions and concerns in a timely, professional manner
• Oversee performance evaluations for direct report staff for approval by VP of Operations on annual basis in accordance with company best practices
• Responsible for human resources matters directly related to department staff under direct supervision including documentation of events or occurrences and verbal counseling direct report staff when attendance or performance deficiencies are discovered
• Responsible for payroll matters directly related to department staff under direct supervision including documentation or direct communication with payroll department
• Assist with scheduling and initial screening of candidates for open positions, reporting to VP of Operations with final decision
• Participate in provider calls and meetings for designated clientele
• May be required to travel overnight and attend meetings or training of various for Hospital Bill Audit review. Must be willing to travel to provider facilities for onsite audits as needed
• Additional duties as assigned executive leadership

KNOWLEDGE & SKILLS:

• Knowledge of acute hospital billing requirements including UB-04’s, itemized bills, revenue codes, CPT/HCPCS codes, ICD10 diagnosis and procedure codes
• Willingness to engage in both tactical, hands-on work, and strategic work as needed to manage and complete priorities
• Ability to write and speak clearly, easily communicating complex ideas across multiple platforms
• Ability to think critically and work independently to meet deadlines and complete priorities
• Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc
• Ability to drive execution by understanding actions and performance necessary for continuous improvement
• Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
• Exceptional organizational skills

EDUCATION & EXPERIENCE:

• Associate’s degree and current RN license in the State of Texas. Bachelor’s or Master’s degree in nursing preferred
• 5+ years of experience in healthcare facility charge audit or related experience
• Previous supervisory/management experience a plus
• Additional certifications in nursing, business management and medical bill review preferred

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: $85,230 – $131,586

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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