Supervisor - Clinical
SCIO Health Analytics - Jacksonville, FL

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The Clinical Supervisor is responsible for supervising all day to day clinical audit activities related to the operations process.

Responsibilities:
  • Direct supervision of support staff, scanning and data entry staff, audit coordinators and/or clinical auditors
  • Resolution and escalation of issues that will impact audits
  • Client relations
  • Assistance with reporting – internal and client
  • Quality control audits and reporting to Manager Level
  • Supervise special project audits for clients as need arises
  • Conduct or assist with selection of audit candidates
  • Recommend selection queries to improve audit result
  • Serve as a reference and expert to audit staff for Medicare (CMS) and Medicaid payment methodologies, and client specific payment methodologies
  • Serve as a subject matter expert to audit staff for client data and interpretation
  • Serve as a subject matter expert to client claims systems
  • Participate in on-going CARES testing and document results
  • Maintain concise records and documentation
  • Ensure all steps of the audit process and policies & procedures are followed
  • Perform or delegate appeals disputes as needed.

Qualifications:

Required:
  • Bachelors Degree or equivalent experience
  • RN, LPN or LVN license required
  • Minimum of 2-5 years actual provider/medical claims processing experience OR
  • 3-5 years previous supervisory experience required
  • Audit experience
  • Minimum of 6 years insurance/healthcare experience
  • Excellent Excel skills, word processing, and database knowledge
  • Excellent verbal and written communication skills
  • Strong analytical skills
  • Ability to prioritize work and demonstrate problem solving skills
  • Team oriented with strong interpersonal skills
  • Self-starter who is an effective time manager
Preferred:
  • Database management experience

SCIO Health Analytics - 16 months ago - save job - block
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