The Diagnostic Related Groups (DRG) Clinical Supervisor is responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical review forms, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination.
This is a remote position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:- Supervises all daily activities of the DRG Clinical Auditors
- Demonstrated knowledge of, ICD-10-CM and PCS codes, and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative
- Completes DRG audits as needed
- Responsible for the overall integrity of the quality of diagnosis and procedure codes verified by the clinical review nurses, for inpatient records and documentation received with the accompanied claim
- Responsible for holding the DRG Clinical Auditors to the quota and error/accuracy rate
- Assists with team coverage and provide support when needed
- May be required to travel overnight and attend meetings or training
- Additional duties as assigned
KNOWLEDGE & SKILLS:- Clinical knowledge of medical necessity rules
- Working knowledge of HIPAA Privacy and Security Rules
- Ability to build strong working relationships both internally and externally
- Strong attention to detail
- Must possess problem solving, critical thinking skills
- Minimal typing experience
- Excellent written and verbal communication skills
- Ability to think and work independently, while working in an overall team environment
- Ability to work in a fast paced/production environment
- Proficient in Microsoft Office applications
EDUCATION & EXPERIENCE:- N./L.V.N. preferred
- CCS or CIC required with DRG auditing experience in ICD-10-CM, ICD-10 PCS
- Proficient in Medicare, CMS guidelines and ICD-10 coding guidelines
- Minimum of 3-5 years of inpatient/DRG auditing experience in a hospital setting and/or payer setting
- A minimum of 2 years of supervisory experience dealing with clinical auditors is required
- Experience with claims denials and appeals required
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: $77,960 - $120,368
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.
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