Sr. Supervisor, Clinical Chart Review

At Zelis, we Get Stuff Done. So, let’s get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

A Little About You

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

The Sr. Supervisor, Clinical Chart Review is focused on supervising a team of Clinician’s performing clinical reviews of facility claims, including UB’s, Itemized Bills and medical records, to verify billing accuracy and clinical appropriateness. The Supervisor will be responsible for monitoring the Clinical 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 team and operational support to the Manager, Clinical Chart Review, Sr. Level Clinicians and Operations Analysts as directed by Sr. leadership.

What you will do:

• Direct supervision of a team of Clinical Reviewer’s.
• Accountable for day-to-day business operations performed by the team.
• Monitor the clinical team’s work output and 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 Manager, Clinical Chart Review.
• Make recommendations to the Manager for process improvement and follow through for proper execution.
• Perform quarterly and as needed Quality Assurance and complete bi-annual assessment of Nurse Reviewer performance. Report these results to the Manager.
• Continuous assessment of results at individual clinician level and make recommendations/changes to enhance outcomes.
• Demonstrate 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 the CCR Manager to enhance “smart screening” or other workflows that increase efficiencies for the team.
• Ensure all team members are executing the Standard Operating Procedures at all times.
• Collaboration with other members of the Expert Claims Review team as needed.
• Partner with Manager and/or Sr. level team members for research of new concepts. Facilitate the adjustment of workflows to accommodate new concepts as needed.
• Provide regular support to the Manager, Clinical Chart Review team as needed or directed.
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy at all times.

What you will bring:

• Current RN/LPN license.
• Demonstrated leadership experience in an advisory role with management of direct reports required.
• Advanced competency in medical claim review and payment integrity preferred.
• Ability to analyze and convert data to excel format and report trends necessary.
• Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.
• Ability to manage day-to-day business operations with minimal supervision and pivot as needed to meet prioritized department and business needs.
• Must have professional manner and respect the confidentiality of administrative matters and files.
• Ability to manage and prioritize multiple tasks with the ability to adapt to meet departmental needs.
• Ability to work under pressure and meet deadlines.
• Effectively communicate with others by giving feedback effectively and concisely.
• Excellent organizational skills are required to prioritize responsibilities, thus completing work in a timely fashion
• Computer proficiency and technical aptitude with the ability to utilize internal systems, EncoderPro, Micromedex, Milliman Care Guidelines, MS Office Suite. Power Point and other audit software & tools.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Base Salary Range

$86,000.00 - $115,000.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com.

Disclaimer

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.