Revenue Integrity Supervisor
Description
At SCP Health, what you do matters.
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Strong track record of providing excellent work/life balance
- Comprehensive benefits package and competitive compensation
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect
What you’ll be doing:
The Revenue Integrity Supervisor of Clinical Appeals is a leadership position focused on overseeing the clinical appeals process, supervising a diverse team of state-side and offshore employees, and ensuring the success of the clinical appeal department. This role requires a background in clinical compliance, medical necessity, critical care, and level of care issues, while also demonstrating the ability to manage cross-functional teams, develop and deliver training programs, and ensure operational efficiency across clinical appeal and audit functions.
- Supervise a team of state-side and offshore employees.
- Develop & manage all training and educational opportunities as required for the development & success of the clinical appeal team and offshore partners. Providing clinical guidance, training, and education as it relates to Compliance, Critical Care, level of care and medical necessity denials.
- Create, revise and manage clinical audits performed by both state side staff and offshore team. This plan should encompass standard clinical criteria, frequency, accuracy threshold and feedback process.
- Manage ETM/user work assignments to ensure deadlines are met.
- Develop a training process for educating/training both state side and offshore on new payer processes, and policies and procedures.
- Performs and administers performance appraisals of staff.
- Serves as the subject matter expert for clinical appeals.
- Collaborate in preparing slides for MOR.
- Meet with team members to review goals, production, audit results and performance evaluations.
- Maintain a working relationship and communicate any chart issues to Documentation Assurance, HiOps and Chart Acquisition.
- Research and document 3rd and 4th level appeals process for all payers. Maintain updates in 'Appeal Timely Filing' document.
- Maintain a working knowledge of coding for all service lines.
- Manage the ALJ prep process for all hearings
- Research Administrative Law Judge (ALJ) hearing process for new plans. Pilot new payers, prepare ROI and advise on recommendations of plans to proceed with this level appeal.
- Participate in Administrative Law Judge (ALJ) (3rd level appeal) hearings. Serving as a clinical and administrative resource for SCP ALJ Appeal Nurse.
- Serve as a backup to Revenue Integrity Manager in creating and distributing weekly production report for medical record, coding, clinical and commercial appeal teams.
- Ensure dept maintains required records procedures in line with coding policies and procedures as HIPAA mandated requirements.
- Attend appropriate professional and educational meetings.
- Perform other duties and assist with additional projects as may be deemed necessary.
What we are looking for:
- Diploma or certificate program earning an LVN or LPN or
- Bachelor of Science in Nursing or Bachelor or Associate degree in Health Information Management
- LVN, LPN or RHIA
- 2-5 years of nursing and/or auditing experience
- Experience to be applied when writing appeals to justify medical necessity.
Utilization/case management experience - Ability to apply Clinical/UM/Case Management knowledge when writing appeals to justify medical necessity.
- Proficient in Microsoft Word and Excel
- Ability to apply clinical experience to write appeals to justify medical necessity.
- Proficient in MicroStrategy
- Ability to learn new reporting tools & systems.
- Advanced experience in software platforms Athena Idx, OnBase, RightFax
- Excellent written and oral communication skills
- Excellent interpersonal skills
- Leadership experience
- Ability to work well in a team environment.
- Professional attitude and demeanor
- Self-starter/problem solver
- Working knowledge of CPT coding, payer regulations and ProCode CDR
This position is eligible for our corporate benefits, please click this link for the details: https://myscpbenefits.com/
SCP Health and its affiliated companies (collectively, “SCP Health”) require applicants for specific positions, such as those onsite at a client company/healthcare facility or affiliate to be vaccinated against COVID-19 as a condition of employment, except where prohibited by state or local law. To demonstrate compliance with SCP Health’s vaccination policy, proof of COVID-19 vaccination status will be requested upon a conditional offer of employment for onsite positions at a client company/healthcare facility. SCP health will consider religious and/or medical/disability accommodation and other legally required exemption request as required by applicable law.
To learn more about SCP Health, please visit:
www.scp-health.com
www.scp-health.com
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SCP Health is an Equal Opportunity Employer.
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