Job Description

At Zelis, we Get Stuff Done. The Sr. Supervisor, Clinical Chart Review oversees a team of Clinician’s performing clinical reviews of facility claims, including UB’s, Itemized Bills and medical records, to verify billing accuracy and clinical appropriateness. The Supervisor will monitor the Clinical Reviewer’s performance to ensure savings are maximized and captured timely through proper claim handling. This role provides leadership guidance to Nurse Reviewers and supports the Manager, Clinical Chart Review, Sr. Level Clinicians and Operations Analysts as directed by Sr. leadership. What You Will Do Direct supervision of a team of Clinical Reviewer’s. Accountable for day-to-day business operations performed by the team. Monitor the clinical team’s work output and queues for timely and proper management of claims. Ensure client turnaround times and specific processing guidelines are followed consistently. Assess, track and report any delays in claim review or processing to the Manager, Clinical Chart Review. Make recommendations to the Manager for process improvement and follow through for proper execution. Perform quarterly and as needed Quality Assurance and complete bi-annual assessment of Nurse Reviewer performance. Report these results to the Manager. Continuous assessment of results at individual clinician level and make recommendations/changes to enhance outcomes. Demonstrate understanding of provider billing nuances and service type trends to drive new ideas and recommend new approaches to the Clinical Chart Review team. Evaluate current concepts and make recommendations to the CCR Manager to enhance “smart screening” or other workflows that increase efficiencies for the team. Ensure all team members are executing the Standard Operating Procedures at all times. Collaboration with other members of the Expert Claims Review team as needed. Partner with Manager and/or Sr. level team members for research of new concepts. Facilitate the adjustment of workflows to accommodate new concepts as needed. Provide regular support to the Manager, Clinical Chart Review team as needed or directed. Maintain awareness of and ensure adherence to Zelis standards regarding privacy at all times. What You Will Bring Current RN/LPN license. Demonstrated leadership experience in an advisory role with management of direct reports required. Advanced competency in medical claim review and payment integrity preferred. Ability to analyze and convert data to excel format and report trends necessary. Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue. Ability to manage day-to-day business operations with minimal supervision and pivot as needed to meet prioritized department and business needs. Professional manner and respect for the confidentiality of administrative matters and files. Ability to manage and prioritize multiple tasks with the ability to adapt to meet departmental needs. Ability to work under pressure and meet deadlines. Effective communication with others by giving feedback effectively and concisely. Excellent organizational skills to prioritize responsibilities and complete work in a timely fashion. Computer proficiency and technical aptitude with the ability to utilize internal systems, EncoderPro, Micromedex, Milliman Care Guidelines, MS Office Suite, Power Point and other audit software and tools. Note: We are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote-friendly culture, and all our employees work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range $86,000.00 - $115,000.00 Zelis is committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers experience, education, qualifications, and job-related knowledge and skills. Base pay is one part of our Total Rewards package, which may also include discretionary bonuses, commissions, or other incentives depending on the role. Zelis’ full-time associates are eligible for a comprehensive benefits package, including 401k with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits (medical, dental, vision, prescription drug). Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com. Disclaimer We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. The statements describe the general nature and level of work and are not an exhaustive list of all responsibilities, duties, and skills required. All personnel may be required to perform duties outside of their normal responsibilities from time to time. Seniority level Mid-Senior level Employment type Full-time Job function Health Care Provider Industries Professional Services Referrals increase your chances of interviewing at Zelis by 2x Get notified about new Clinical Supervisor jobs in Atlanta, GA . We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr Zelis

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