Supervisor, Clinical Chart Review
Company: Premier Healthcare Exchange, Inc.
Posted on: June 12, 2021
The Supervisor, Clinical Chart Review is primarily focused on
supervising a team of nurses performing clinical reviews of
facility claims, including UB's, Itemized Bills and also medical
records to verify billing accuracy and clinical appropriateness.
The Supervisor will be responsible for monitoring the Nurse
Reviewer's performance to ensure savings are maximized and captured
timely through proper claim handling. Effective and proven
leadership experience is a must as recommendations to the Nurse
Reviewer's regarding their claim management is required.
Additionally, this role is responsible for providing daily team and
operational support to the Director, Clinical Chart Review and the
entire Hospital Bill Review leadership team.
- Supervising a team of Nurse Reviewer's is required.
- Monitoring Nurse Reviewer's work 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 Director, Clinical Chart Review.
- Make recommendations to the Nurse Reviewer's for process
improvement and follow through for proper execution.
- Perform quarterly Quality Assurance claim reviews and complete
bi-annual assessment of Nurse Reviewer performance.
- Continuous assessment of results at individual Nurse Reviewer
level and make recommendations/changes to enhance outcomes.
- Demonstrates 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 enhance
- Research and implement third party tools/software, training and
methodologies to ensure auditing success.
- Evaluate, update and maintain the Standard Operating Procedures
for the Clinical Chart Review team.
- Collaboration with other members of the Hospital Bill Team
- Partner with the Team lead to research new concepts and adjust
workflows as needed.
- Maintain awareness of and ensure adherence to Zelis standards
Technical Skills / Knowledge:
- Demonstrates solid understanding of audit techniques,
identification of revenue opportunities and financial negotiation
- Ability to analyze and convert data to excel format and report
- Proficiency in training techniques aimed at conveying subject
matter expertise and scaling staff to maximize savings and
- Computer proficiency and technical aptitude with the ability to
utilize internal systems, EncoderPro, Micromedex, Milliman Care
Guidelines, MS Office Suite and other audit software & tools.
- Thorough knowledge of company and departmental policies and
- Strong leadership and team management experience required.
- Requires minimal daily supervision.
- Daily claim and performance review of the Clinical Chart Review
- Ability to follow detailed instructions on new
- Accountable to day to day tasks
- Must have professional manner and respect the confidentiality
of administrative matters and files.
- Required to evaluate daily tasks and pivot as necessary to meet
- Ability to manage and prioritize multiple tasks with the
ability to adapt to meet departmental needs.
- Ability to work under pressure and meet deadlines.
- Makes logical suggestions as to likely causes of problems and
independently recommends solutions.
- Excellent organizational skills are required to prioritize
responsibilities, thus completing work in a timely fashion.
- Outstanding ability to multiplex tasks as required.
- Excellent project and people management skills.
- Attention to detail and concern for impact is essential.
- Provides guidance to lower level personnel.
- Regularly attends meetings and leads training sessions as
- Must be proactive to ensure proper follow up and completion of
- Must maintain a professional demeanor in sensitive
- Assists other departments as necessary.
- Must work well with others.
- Effectively communicate with others by giving and receiving
- Communicates ideas and information clearly.
- Must have excellent communication and presentation skills to
effectively interface with the entire staff, and external
representatives from the business, financial, legal and scientific
- Travel requirements to (primarily) domestic destinations should
not exceed 10%.
- RN is required.
- 5+ years of relevant experience or equivalent combination of
education & work within healthcare payers.
- Experience and working knowledge of Health Insurance, TPA's,
Medicare guidelines and various healthcare programs.
- Experience managing a team is required.
- Experience with payment integrity is preferred.
- Strong clinical skills to evaluate appropriate medical record
- Demonstrates a proficiency in analyzing hospital claims and
medical record documentation.
- Demonstrated track record of success in managing key process
- Industry experience implementing complex programs.
- Experience managing internal relationships.
- Excellent and professional verbal & written communication
- Walking, standing and sitting.
- Long periods of computer usage.
- Handling - seizing, holding, grasping and fingering of objects,
tools and controls.
- Vision - close vision.
- Hearing- ability to receive detailed information through oral
and telephonic communication.
- Ability to lift and move approximately thirty (30) pounds on a
- Ability to sit for extended periods of time.
- A standard work week exists but with the understanding that
additional time/effort outside of the usual parameters can/will
occur based upon the overall needs of the integration, where
deadlines exist and when necessary due to the needs of the
- A standard business environment exists with moderate noise
Zelis is a healthcare and financial technology growth company
and market-leading provider of claims cost management and payments
optimization solutions to price, pay and explain healthcare claims.
Zelis delivers integrated network analytics, network solutions,
payment integrity, electronic payments and claims communications
for payers, healthcare providers and consumers in the medical,
dental and workers' compensation markets nationwide. Zelis is
backed by Parthenon Capital Partners and Bain Capital.
"We are an equal opportunity employer and all qualified
applicants will receive consideration for employment without regard
to race, color, religion, sex, national origin, disability status,
protected veteran status, or any other characteristic protected by
Keywords: Premier Healthcare Exchange, Inc., Newark , Supervisor, Clinical Chart Review, Other , Bedminster, New Jersey
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