Senior Manager Clinical Audit

CERIS•Fort Worth, TX

12d•$92,673 - $143,587•Remote

About The Position

The Senior Manager, Clinical Audit is responsible for planning, leading, and coordinating multiple teams of auditors and associated billing staff in a fast paced, productivity-based environment to achieve organizational goals. This role oversees auditors performing varying types of medical bill reviews and audits utilizing medical records, itemized bills, and other auditing and coding tools. The Senior Manager, Clinical Audit, also be required to perform onsite facility visits and must be willing to travel for both site visits and other meetings as needed. In this role, the Senior Manager, Clinical Audit will need to use critical thinking and analytical skills to make knowledge-based decisions in a fast-paced production environment. This is a remote position.

Requirements

Knowledge of hospital billing requirements including UB-04, HCFA1500, 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 proficient in Microsoft Office applications including Excel
Must have exceptional organizational skills
Registered Nurse licensure required
RNs are required to keep current and unencucumbered licensure in the state of employment
5+ years of experience in healthcare billing audit or related experience required
3+ years previous leadership experience required

Nice To Haves

Bachelor’s or master’s degree in nursing or related healthcare field preferred
Additional certifications in nursing, coding, business management and/or medical bill review a plus

Responsibilities

Utilize education, experience, and industry best practices to lead teams of auditors to plan, execute and deliver timely and accurate results
Professional and timely communication with clients, account management and other departments
Build, lead, and manage remote and/or onsite teams made up of managers, supervisors, and staff through hiring, onboarding, ongoing career development, and a positive team environment
Work directly with managers and supervisors to implement performance metrics and evaluation systems to assess individual and team performance
Responsible for all HR related duties for direct and indirect staff
Responsible for managing and maintaining all KPIs and adherence to SLAs, identifying and resolving problems, preparing, and completing action plans to drive process improvement
Responsible for tracking and reporting departmental metrics to director or executive leadership as requested
Responsible for monitoring and compliance with turnaround times and other SLAs as required by our clients
Responsible for daily, weekly, monthly reviews of various reports, invoices, logs, and expenses
Acts as a point of contact for both internal and external customers
Maintain HIPAA/patient confidentiality
Additional duties as assigned
Partner collaboratively with internal teams across CERIS and CorVel
Foster a culture of collaboration, professionalism, support, and cooperation
Provide constructive feedback and coaching to improve performance and achieve department goals
Promote a culture of integrity, transparency, and accountability
Promote open, transparent communication across teams to ensure concerns, risks, and challenges are surfaced early and addressed collaboratively
Foster an environment of mutual respect and trust when engaging with internal partners, clients, and external stakeholders
Model and reinforce professional conduct, accountability, and integrity in all interactions and decision-making
Promote inclusivity, professionalism, and cooperation to enhance team cohesion and organizational culture