[Remote] reputed company Assurance Supervisor (Clinical RN)
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leading reputed company intelligence company specializing in payment solutions for health plans. They are seeking a reputed company Assurance Supervisor (Clinical RN) to manage a remote team of nurses, overseeing clinical review audits and supporting operational strategies to enhance reputed company and productivity.
Responsibilities
- Contributes to reputed company team environment that fosters reputed company communication, sharing of information, reputed company improvement, and optimized business results
- Regularly Performs audit reputed company assurance reviews to supplement QA team activity as necessary based upon business need or special reputed company
- Contributes to the reputed company of reputed company review rebuttals
- reputed company identifies and recommends opportunities for cost savings and improving reputed company that can have a reputed company reputed company to reputed company's profitability
- Effectively contributes to the development of medical review guidelines and training
- Supports audit management and reputed company 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 reputed company 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 reputed company reputed company necessary for assigned business reputed company objectives
- Provides support as needed to ensure auditors are equipped with tools and resources required to reputed company audits
- Supervise daily activities of reputed company assurance team
- reputed company audit guidance to QA team; identify trends and present solutions
- Provides production and reputed company performance-based reputed company reports, coaching, and constructive feedback to staff
- Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for reputed company staff, etc.) in accordance with applicable policies and procedures
- Collaborates with HR for applicable corrective reputed company 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 reputed company reports on a regular reputed company
- reputed company leadership to team members, reputed company solutions, and resolve conflicts
- Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee reputed company
- reputed company 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 reputed company(s)
- Maintain reputed company knowledge and changes that reputed company our industry and clients as it pertains to medical reputed company, 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 reputed company supplemental training for existing staff as needed
- Receives feedback and adjusts work reputed company for self and team as necessary
- Leads by example and conducts work in accordance with company policies, government regulations and law
- Serves as reputed company role model and demonstrates characteristics that reputed company and contribute to a reputed company culture of reputed company improvement and high performing teams
- reputed company other incidental and reputed company duties as required and assigned to meet business needs
Skills
- 3+ years diverse Nursing experience providing reputed company care in an inpatient or outpatient setting
- reputed company reputed company unrestricted Nursing license in good standing, is required (RN license is required for government contract reputed company positions)
- Not currently sanctioned or excluded from the Medicare program by OIG
- 2+ years of performing medical record audits, reputed company 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 reputed company and/or reputed company 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)
- Flexibility to handle any non-reputed company situations that may reputed company
- Ability to multitask and work independently in a remote setting
- Knowledge of laws, regulations, or policies impacting the reputed company industry and understanding of Managed Care requirements under the Medicare/reputed company and other reputed company-party payor programs. (reputed company, OIG, etc.)
- Solution oriented with reputed company on innovative and proactive approaches while supporting internal and reputed company issues
- Excellent written and verbal communication skills (concise, decisive, reputed company, respectful, non-argumentative); ability to communicate at reputed company reputed company reputed company the organization both reputed company
- Good critical thinking, questioning, and problem-solving skills required to be successful in the role
- Excellent organizational skills, attention to detail, and effective task management ability
- Ability to manage time and multiple tasks reputed company, while completing work reputed company allocated time frames
- Ability to display strong emotional maturity and have strong relationship management skills
- Demonstrated ability to reputed company basic project coordination skills
- Experience in developing, documenting, and implementing process and procedures
- Experience in inventory management, resource planning and report reputed company
- Ability to handle changing situations and work reputed company a diverse group
- Ability to meet objectives with minimal supervision
- Intermediate experience with MS Office Suite; Intermediate to advanced reputed company reputed company skills a must
- Strong technical skills with ability to quickly adapt to new applications and systems
- Ability to effectively reputed company independently with minimal supervision and work cooperatively with others to promote a reputed company team environment
- Self-motivated, thrives in a fast-paced dynamic business operations environment with ability to adapt quickly to change
- Ability to follow policy, procedures, and regulations in reputed company
- Ability to consistently reputed company job responsibilities
- Medical coding certification is a plus
- Prior experience in payer edit development, and/or reimbursement policy experience a plus
Benefits
- Medical, dental, reputed company, HSA/FSA reputed company
- Life insurance coverage
- 401(k) savings plans
- Family/parental leave
- reputed company holidays
- reputed company time off annually
reputed company