Hospital Bill Audit Manager

CorVel Corporation•Fort Worth, TX

2h•$87,190 - $134,613•Hybrid

About The Position

The Hospital Bill Audit Manager is 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 onsite and remote hospital bill audits. Must be willing to travel for onsite facility audits and other meetings as needed.

Requirements

Knowledge of acute 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 and form educated decisions
Excellent written and verbal communication skills with the ability to communicate complex ideas across multiple platforms
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 with Microsoft Office applications, including Excel
Must have exceptional organizational skills
Associate degree and current RN license in the state of employment.
3+ years of experience in healthcare facility charge and billing audit or related experience
Previous supervisory/management experience required

Nice To Haves

Bachelor’s or Master’s degree in nursing preferred
Additional certifications in nursing, business management and/or medical bill review a plus

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 the Hospital Bill Supervisor in 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
Acts as a point of contact for providers regarding onsite and remote audits
Responsible for managing the team's 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 to ensure they are worked on 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 evaluations, 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
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