DME Supervisor

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee staff and operational outcomes for a remote team comprising nurses and various audit roles.

• Conduct a limited number of clinical audits to uphold subject matter expertise and address business needs.

• Execute quality assurance reviews for audits and assist in addressing quality review rebuttals.

• Carry out reviews or activities related to appeals as necessary.

• Identify and suggest opportunities for cost savings and improvement in outcomes.

• Ensure compliance of staff with medical review guidelines and training protocols.

• Assist audit management and segment specialists in implementing new concepts.

• Aid in needs assessments and planning for capacity.

• Monitor business inventory assigned, pinpoint potential backlogs, and align resources to fulfill business requirements and SLAs.

• Supervise and evaluate audit determinations to ensure consistent decision-making.

• Collaborate with various departments to address operational challenges.

• Manage staffing levels and ensure that auditors have the necessary tools and resources.

• Oversee daily functions of clinical audit personnel.

• Offer audit guidance, identify trends, and propose solutions.

• Deliver performance reports, coaching, and constructive feedback.

• Manage team attendance and conduct performance evaluations.

• Hold regular team meetings and mediate conflicts.

• Escalate employee issues and collaborate with management, HR, and the People Team.

• Provide operational and staff activity updates to management.

• Engage in department and client-facing meetings, investigate issues, present findings and solutions, and/or deliver training.

• Monitor third-party/subcontractor inventory and activities as necessary.

• Act as a subject matter expert for designated business segments.

• Keep abreast of current medical practices, technology, regulations, legislation, and industry trends.

• Develop or assist in creating training materials, tools, and best practices.

• Identify training needs and facilitate training for both new and existing audit staff.

• Promote continuous improvement, open communication, information sharing, and optimized business performance.

• Model exemplary behavior and adhere to company policies, government regulations, and legal requirements.

• Perform additional related duties as assigned.

⛳️ Requirements

• A current active unrestricted Nursing license in good standing is required.

• Must not be sanctioned or excluded from the Medicare program by OIG.

• At least 3 years of diverse nursing experience providing direct care in inpatient or outpatient environments.

• A minimum of 2 years performing medical record audits in either a provider or payer setting for a health insurance company.

• At least 5 years of experience in health care claims demonstrating proficiency in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG, and medical billing experience for an insurance company or hospital is required.

• Candidates with fewer than 5 years of experience may be considered based on demonstrated skills, formal training, and other relevant experience.

• Preferred: 3+ years of relevant supervisory or leadership experience in a similar business environment.

• Experience in managing remote staff is a plus.

• Medical coding certification is advantageous.

• Strong understanding of medical documentation requirements and CMS, Medicaid, and/or Commercial insurance programs.

• Familiarity with CPT/HCPCS/ICD-9/ICD-10/MS-DRG coding.

• Proficient in CMS-1500/UB-04 forms.

• Working knowledge of coding encoders.

• Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines, Milliman, or InterQual.

• Ability to review, analyze, and research issues related to medical billing, documentation, and coding.

• Experience as a reimbursement policy and/or claims software analyst.

• Familiarity with interpreting electronic medical records (EHR).

• Experience in developing, documenting, and implementing processes and procedures.

• Experience in inventory management, resource planning, and report generation.

• Strong skills in analysis, technical proficiency, critical thinking, organization, prioritization, time management, editing, proofreading, and decision-making.

• Experience in leading, motivating, coaching, and developing teams.

• Intermediate Excel skills and proficiency with MS Office, application reporting tools, and case management systems/tools.

• Ability to learn and adapt to new systems and tools.

• Ability to work independently in a remote setting with minimal supervision.

• Capability to work flexibly in a fast-paced environment with shifting priorities.

🏝️ Benefits

• Equal employment opportunity.

• Reasonable accommodation during the application or recruitment process.

• Employment at will.

• Participation in E-Verify as required by applicable law.