Job Code:2019-50-6A-001Location:Remote - Sunrise, FLStatus:Regular Full Time
Responsibilities:The Medical Review Manager is a key member of the HCS organization and supports building a world class healthcare services organization. This role directs the timely delivery of high quality audits for our business ensuring organizational goals are met. This position will provide direct oversight of multiple departments.
•Develops and executes on audit plans, in accordance with internal audit standards and relevant statement of work
•Prepares reports and manages audit activities for assigned clients
•Applies in depth level of expertise in development of policies and procedures and workflows processes to review claims, and identify processing, procedural, systemic and billing errors and practices leading to claims inaccuracies
•Manages team members performing audit activities to identify trends, determine root cause of payment inaccuracies, and to recommend process and systems improvements
•Proactively identifies opportunities for process improvement, efficiency, resolving problems, preparing and completing action plans
•Manages and trains team leaders and audit staff. Supports staff recruitment, develops auditors and builds effective teams.
Supports subcontractor communication, oversight and reporting.
•Establishes accountability for performance monitoring (productivity/quality), communicates job expectations, trends, documentation, and ensures timelines are met
•Supports strategy by conducting needs assessments, capacity planning, cost/benefit analyses; preparing staffing models, establishing productivity and quality standards
•Maintains professional and technical knowledge by tracking emerging trends in audit management; attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies
•Develops effective relationships with leaders in the organization and has a strong understanding of the business
•Applies in-depth understanding of the inter-relationships of the business and support units throughout the organization
•Accomplishes organizational goals by accepting ownership of requests; exploring opportunities to add value
•Participates in business initiatives and pro-actively advises and assists the business on initiatives
•Builds HCS value and credibility with internal and external clients and represents the organization in meetings with the client, provider organizations, contractors, subcontractors and vendors
•Uses excellent communication skills in order to influence a wide range of internal and external audiences
•Provides timely response to escalated inquiries from the client and providers
•Supports other departments in problem resolution as necessary
•Completes required reports and ad hoc requests for information
•Inspires trust and credibility- delivers on commitments, audit subject matter expert
•Facilitates meetings as necessary
•Performs other duties as assigned
Required Skills and Knowledge:Possess a broad and comprehensive understanding of audit standards, policies and regulations, applies a broad and comprehensive knowledge in areas including, medical chart reviews
•Strong project management and interpersonal skills, makes sound decisions, exhibiting initiative and intuitive thinking. Consulted often by others for advice and opinions and recognized as a leadership role model.
•Problem solving, strong analytical skills, people skills, teamwork, people management, and managing processes.
•Strong interpersonal skills for interfacing with all levels of internal and external audit teams and management.
•Ability to prioritize and multi task.
•Must be a strong effective communicator, both orally and in writing, with an energetic, charismatic and approachable style.
•Proven experience in managing high performing dynamic teams.
•Ability to work in a diverse and fast paced environment.
•Strong working knowledge of MS Office
•Sit/stand/walk 8-12 hours/day
•Lift/carry/push/pull under and over 10lbs occasionally
•Keying frequency, handling, reaching, fine manipulation
Education and Experience:
•BA/ BS or 10+ years of business experience in healthcare with increasing responsibility
•Prior experience in the Health Care industry
•Registered Nurse with an unrestricted nursing license with 7+ years experience in managing staff in a healthcare related industry
-Must submit to and pass background check.
-Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors.
-Must submit to and pass drug screen.
Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.
Job Profile is subject to change at any time.
Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.