Itemization Review Supervisor

CorVel Career Site•Fort Worth, TX

4d•Remote

About The Position

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. 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!).

Requirements

Comprehensive knowledge of departmental policies and procedures related to Itemization Review
Advanced understanding of client payment policies as they apply to reviews
Familiarity with quality control processes
Strong organizational, strategic thinking, and critical analysis skills
Excellent written and verbal communication skills
Ability to manage high-pressure situations and adapt to changing priorities
Proven leadership, problem-solving, and analytical capabilities
Ability to work both independently and collaboratively
Skilled in organizing and facilitating monthly team meetings with a focus on training and development
Proficiency in MedCheck, MedCheck Select, CareMC, Tableau, UKGPro, departmental policies and procedures, and Microsoft Office Suite (including Excel, Outlook, and Teams)
Must maintain current licensure as a Registered Nurse (RN) 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.
At least 3 years of experience in a hospital supervisor or manager role
Associate Degree in Nursing or higher
Minimum of 3 years’ experience in LIBR preferred
Experience in medical bill auditing preferred
Knowledge of ICD-10, DRG and coding preferred

Responsibilities

Maintain accurate, current data and analytics to support informed decision-making and reliable outcomes
Manage and track client appeals as required
Oversee the file assignment process and continuously monitor nurse workloads and queues
Ensure daily prioritization of all claims is clearly understood and executed
Prepare and maintain monthly metrics and reporting
Demonstrate working knowledge of CERIS systems and databases
Lead and support the team with minimal managerial oversight
Foster a collaborative and positive work environment through effective team leadership
Ensure strict adherence to HIPAA compliance standards
Additional duties as assigned