Job Description

Job Description

Job Description

The PPI Clinical Review Manager is responsible for the overall aspects of the PPI Clinical Review Department including personnel hiring, quality assurance of product, workflow, maintaining the tracking of and accountability of staff regarding production standards and turn-around expectations.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES :

• Responsible for managing the daily file flow coming into Clinical Review while maintaining awareness of potential file flow from other departments to track rush or special files, test files, pilot studies for prospective clients
• Responsible for meeting client specific turnaround times and metrics
• Writing performance evaluations for direct report staff on annual basis as per CorVel/CERIS guidelines
• Keeping Department error ratio to less than 2% on all approved files completed per month
• Responsible for human resources matters directly related to department staff under direct supervision including documentation of events or occurrences and verbal counseling direct report staff when attendance or performance deficiencies are discovered
• Train, Assist and Direct Supervisors as needed
• Requires regular and consistent attendance and the tracking of attendance of staff under direct supervision, in addition to ensuring adequate staffing levels to meet business needs and productivity standards
• Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
• Responsible for implementing new procedures/protocols as necessary
• Responsible for identifying process improvement opportunities and reporting these to the director of audit
• Responsible for maintaining and updating department protocol library
• Responsible for monitoring various reports daily to ensure productivity metrics and client goals are met
• Assist with additional projects as requested
• Participate in provider and client calls as needed
• Participate in leadership calls as needed
• May be required to travel overnight to attend meetings and/or training
• Additional duties as assigned by director of audit and/or SVP of operations

KNOWLEDGE & SKILLS:

• Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines
• Extreme attention to detail
• Must possess problem solving, critical thinking skills
• Must be team oriented
• Effective and professional communication skills, both verbal and written
• Ability to act in a professional manner with both internal and external customers
• Ability to think and work independently
• Ability to work in a fast-paced production environment
• Proficient in Microsoft Office Suite

EDUCATION & EXPERIENCE :

• Minimum of 3-5 years of inpatient/DRG coding experience in a group health payment integrity setting or 3 party audit company
• A minimum of 2 years supervisory experience dealing with clinical auditors preferred
• Appropriate certification through AHIMA or AAPC with DRG coding experience in ICD-10, ICD-10 PCS, CPT and HCPCS
• RN licensure with DRG coding experience and certifications as above a plus
• Degree in healthcare related field preferred

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $80,718 – $124,624

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

#LI-Remote

Job Tags

Similar Jobs