ABOUT THE OPPORTUNITY:
Hiring Range: $95,000 - $105,000
TheSupervisor, 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.
Key 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.
Knowledge Skills and Abilities Needed:
Flexibility to handle any non-standard situations that may arise. Ability to multitask and work independently in a remote setting.
Knowledge of laws, regulations, or policies impacting the Healthcare industry and understanding of Managed Care requirements under the Medicare/Medicaid and other third-party payor programs. (Commercial, OIG, etc.)
Solution oriented with focus on innovative and proactive approaches while supporting internal and client issues.
Excellent written and verbal communication skills (concise, decisive, direct, respectful, non-argumentative); ability to communicate at all levels within the organization both internal and external. Demonstrated ability to work effectively in professional setting in collaboration with internal cross-functional teams and clients.
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 efficiently, while completing work within allocated time frames
Ability to display strong emotional maturity and have strong relationship management skills. Demonstrates high emotional intelligence, managing yourself and relationships effectively, through self-awareness, self-management, awareness of others and skill in dealing with a variety of personalities.
Demonstrated ability to employ basic project coordination skills.
Experience in developing, documenting, and implementing process and procedures.
Experience in inventory management, resource planning and report generation.
Ability to handle changing situations and work within a diverse group.
Ability to meet objectives with minimal supervision.
Intermediate experience with MS Office Suite; Intermediate to advanced Microsoft Excel skills a must.
Strong technical skills with ability to quickly adapt to new applications and systems.
Ability to effectively perform independently with minimal supervision and work cooperatively with others to promote a positive 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 the workplace.
Ability to consistently perform job responsibilities.
Requirements & Qualifications
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 DRGs 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)
Medical coding certification is a plus.
Prior experience in payer edit development, and/or reimbursement policy experience a plus.
WHAT WE OFFER:
Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.
Physical Requirements & Additional Notices:
If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employees responsibility to maintain this Internet access at their home office location.
The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.
Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.
Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).
Regularly sit/stand 8 or more hours per day.
Occasionally lift/carry/push/pull up to 10lbs.
