Itemization Review Nurse Supervisor

Job Description

Job Description

The Itemization Review Supervisor will maintain a positive team building approach with emphasis on reporting, leadership and professional communication with all CERIS departments.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Maintain all data and analytics information to make critical decisions and accurate results
• Maintain all appeals from all clients as required
• Knowledge of and understanding all departmental policies and procedures as they relate to Itemization Review
• Advance knowledge of Client Payment Policy for reviews
• Knowledge of Quality Control processes as needed
• Fully understands process of assigning files and assessing nurse’s queues continually
• Fully understands the priority of all claims daily
• Maintains monthly matrix reporting
• Knowledge of CERiS systems and Data Base informatics
• Maintain teams with minimum assistance from manager
• Create a team by promoting a positive work environment
• Additional duties/responsibilities as assigned by manager
• Comply with all safety rules/regulations, in conjunction with the Injury and Illness Prevention Program (“IIPP”), as well as, maintain HIPAA compliance
  

KNOWLEDGE & SKILLS:

• Advance organizational, strategic and critical thinking skills
• Effective and professional communication skills
• Ability to handle stressful situations and adapt accordingly
• Demonstrated outstanding leadership, problem solving, and analytical skills
• Ability to think and work independently
• Proficient in scheduling monthly team meetings with emphasis on education
• Proficient in MedCheck, MedCheck Select, CareMC, Tableau, UltiPro, Department Employee Handbook Policy and Procedures, Microsoft Office Suite, Excel, Outlook, and Skype for Business
  

EDUCATION & EXPERIENCE:

• Must maintain current licensure as a Registered Nurse in the state of employment
• Must have a minimum of 5 years’ experience in the O.R., ICU, or E.R. as an R.N.
• Must have a minimum of 3 years’ experience in LIBR. Preferred but not mandatory
• Must have 3 years or Hospital Supervisor/Manager experience
• Associate Degree in Nursing or higher
• Experience in medical bill auditing, preferred but not mandatory
• Knowledge of ICD-10, DRG and coding required but not mandatory