Quality Assurance Supervisor (Clinical RN)

Performant Corp•Plantation, FL

4d•Remote

About The Position

The Supervisor, Quality Assurance (Clinical) leverages their nursing background, clinical review, and experience leading others to manage staff and operational results for a remote team of nurses and other audit roles, performing clinical review audits. The Supervisor is primarily responsible for leveraging first-hand experience and knowledge of claims auditing, supporting management with strategy activities such as needs assessments, capacity planning, preparing staffing models, ensuring required staffing levels, cost/benefit analysis, and establishing productivity and quality standards.

Requirements

3+ years diverse Nursing experience providing direct care in an inpatient or outpatient setting.
Current active unrestricted Nursing license in good standing, is required (RN license is required for government contract focused positions)
Not currently sanctioned or excluded from the Medicare program by OIG
2+ years of performing medical record audits, quality reviews in a provider setting, or in a payer setting for a health insurance company.
Demonstrated experience gathering, researching, and documenting data and requirements for projects and/or complex problem solving.
3+ years prior experience in supervisory or leadership in similar business environment (preferably experience overseeing remote staff).
3+ years in health care claims that demonstrates expertise in DRG’s and medical billing experience for an Insurance Company or hospital required. (less than 3 yrs. may be considered for internal candidates based upon demonstrated skills and results)

Nice To Haves

Medical coding certification is a plus.
Prior experience in payer edit development, and/or reimbursement policy experience a plus.

Responsibilities

Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results.
Regularly Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects.
Contributes to the resolution of quality review rebuttals.
Actively identifies and recommends opportunities for cost savings and improving outcomes that can have a direct impact to the company's profitability.
Effectively contributes to the development of medical review guidelines and training.
Supports audit management and segment specialists with activities for new concept implementation, maintenance of medical review guidelines for existing concepts.
Use data, reports, and experience to identify potential backlogs and align resources to meet business needs and SLAs.
Collaborate with other departments to resolve operational problems.
Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing levels necessary for assigned business segment objectives.
Provides support as needed to ensure auditors are equipped with tools and resources required to perform audits.
Supervise daily activities of quality assurance team
Provide audit guidance to QA team; identify trends and present solutions.
Provides production and quality performance-based progress reports, coaching, and constructive feedback to staff.
Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures.
Collaborates with HR for applicable corrective action as applicable.
Complete and conduct performance reviews for assigned staff.
Routinely review QA scorecards for accuracy and education, QA of the QA.
Conduct team meetings with direct reports on a regular basis.
Provide leadership to team members, provide solutions, and resolve conflicts.
Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee matters.
Provide reporting and updates to management as required and appropriate for operational and staff activity and results.
Participates in and contributes to applicable department meetings.
May support management with activities to monitor inventory and activity of 3rdparty/subcontractors.
Become subject matter expert for assigned business segment(s).
Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends.
May support training material/tools and best practices development.
Identify needs and ensure team receives necessary training.
Support training activities for new audit staff or provide supplemental training for existing staff as needed.
Receives feedback and adjusts work priority for self and team as necessary.
Leads by example and conducts work in accordance with company policies, government regulations and law.
Serves as positive role model and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams.
Perform other incidental and related duties as required and assigned to meet business needs.