Clinical Supervisor, Denial Management RN

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

The Supervisor, Clinical Appeals is responsible for denials management of clinical appeals services on behalf of Corro Clinical clients. They will provide leadership and oversee daily operations of an Appeals team comprised of Appeal Coordinators and additional support staff – including relationships, performance management, and quality assurance. They will provide regular support, mentorship, and guidance for their team members – and are responsible for the development and growth of such. The Supervisor, Appeals is also responsible for organizing and overseeing processes and workflows within the Appeals team, ensuring that their team members understand and can execute duties or delegated tasks. Interaction with internal and external customers, including payers is expected.

This is a remote position.

RN license in good standing is required.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Responsibilities:

Performance Management of Staff, Revenue Cycle Management with KPI, People management activities, Root Cause Analysis of Denials, Interdepartmental Coordination, Workflow development, Escalation Management, Prepares and Reports Operational Progress, Relationship management with the team and external parties, Training Coordination, Document preparation, Compliance Oversight, and Documentation Review/Auditing.

 

Qualifications & Skills Required:

• RN required
• Experience directly managing a team preferred
• Excellent communication and interpersonal skills, especially to connect to remote team members and internal/external customers
• Outstanding organizational and leadership skills
• Refined ability to delegate responsibilities and provide leadership and training to key personnel
• Excellent critical thinking skills
• Ability to provide strategic thought to process improvement or standardization
• Confidentiality
• Strict adherence to HIPAA/HITECH compliance

 

Education & Experience: 

• RN degree, License Required
• Payor and Provider Appeal Experience Preferred.
• Knowledge of CPT and ICD 10 guidelines
• Knowledge of Medicare/Medicaid/Commercial/Managed Care
• CDI, CCS, DRG appeals experience Preferred and a Plus.
• RN degree preferred
• (3) to (5) years of experience/prior working knowledge in healthcare, Insurance, specifically in denials management/claims and Appeal writing.
• Experience working in Epic
• Proficient in relevant computer applications such as MS Office, accurate keyboard skills, Teams
• Ability to collaborate with staff, and other departments within the hospital system.

Remote Work from Home Day time Business hours CST/EST

 

This is a remote position.

 

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.