Medical Review Audit Supervisor - Clinical (Commercial Home Health)

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range: $78,500 - $93,000

The Medical Review Audit Supervisor - Clinical (Commercial Home Health) leverages their nursing background, deep knowledge of clinical review, and experience leading others to manage staff and operational results for a remote team of nurses and other audit roles, performing clinical review audits. The Supervisor will leverage first-hand experience and knowledge of claims auditing for supporting management with strategy activities such as needs assessments, capacity planning, and ensuring required staffing levels and productivity & quality standards are being achieved consistently.
 

Key Responsibilities to include:

• Regularly performs limited volume of clinical audits to maintain subject matter expertise, and additionally as needed to support business needs.

• Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects.

• Contributes to the resolution of quality review rebuttals.

• May perform appeals review/activity to supplement Appeals team, based upon business need.

• Actively identifies and recommends opportunities for cost savings and improving outcomes that can have a direct impact to the company's profitability.

• Effectively ensures adherence to medical review guidelines and training requirements of staff.

• Supports audit management and segment specialists with activities for new concept implementation

• Supports management with needs assessments and capacity planning

• Monitor and manage inventory of assigned business to ensure timelines are met. 

• Use data, reports and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs.

• Oversee and review audit determinations to ensure consistency in decision-making.

• Collaborate with other departments to resolve operational problems.

• Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing levels necessary to achieve business objectives.

• Provides support as needed to ensure auditors are equipped with tools and resources required to perform audits.

• Supervise daily activities of clinical audit staff that may include both salaried exempt and hourly employees.

• Provide audit guidance to medical review staff; identify trends and present solutions.

• Routinely provides production and quality performance-based progress reports, coaching, and constructive feedback to staff.

• Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures.

• Collaborates with The People Team for applicable corrective action as applicable.

• Complete and conduct performance reviews for assigned staff.

• Conduct team meetings with direct reports on a regular basis.

• Provide leadership to team members, provide solutions, and resolve conflicts.

• Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee matters.

• Provide reporting and updates to management as required and appropriate for operational and staff activity and results.

• Participates in and contributes to applicable department meetings.

• May participate to client-facing meetings; research and analyze issues; present findings and solutions; and/or provider training.

• May support management with activities to monitor inventory and activity of 3rd party/subcontractors.

• Become subject matter expert for assigned business segment(s).

• Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, le