Medical Claims Review Manager jobs in Fort Worth, TX

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

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
• Responsible for managing the daily file flow coming into Medical Review while maintaining awareness of potential file flow from other departments to track rush or special files, test files, pilot studies for prospective clients
• Writing performance evaluations for direct report staff on annual basis as per CorVel/CERIS guidelines
• Responsible for meeting client specific turnaround times and metrics
• Responsible for quality of review results and an error rate of less than 2% on all completed files 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
• 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:
• Understanding of audit guidelines including CMS and payor policies
• 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:
• Associate degree and current RN license required.
• Bachelor’s or master’s degree in nursing or other healthcare related field preferred
• Previous supervisory experience required
• Previous nurse audit or payment integrity experience preferred

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.