Claims Quality Audit Supervisor supervises and coordinates daily activities of claims quality auditors. Provides assistance in developing claims audit policies and procedures. Being a Claims Quality Audit Supervisor solves day-to-day problems and monitors the results of daily staff activities, reports critical issues and problems to the management. Typically requires a bachelor's degree. Additionally, Claims Quality Audit Supervisor typically reports to a manager. The Claims Quality Audit Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Thorough knowledge of department processes. To be a Claims Quality Audit Supervisor typically requires 3-5 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)
The CDI Specialist will identify potential gaps in clinical documentation for inpatient and payer populations as directed throughout the hospitalization. He/she will also educate physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record. In addition, the following are highly desired: RHIT, RHIA, CDIP, CCDS, CCS and ICD-10 certification or designation. Must possess at least five years of acute hospital nursing experience (e.g. medical/surgical unit, intensive care). Experience in Utilization Management/Case Management, Critical Care, patient outcomes/quality management and/or inpatient coding considered a plus. ICU/Critical Care experience strongly desired. Prior experience in clinical documentation improvement, ICD coding and MS-DRGs preferred. Prior experience educating physicians/providers preferred. Previous experience working in a clinical documentation improvement department or as a consultant strongly encouraged. Minimum of one-year auditing experience strongly encouraged. This individual must possess a comprehensive knowledge of medical terminology, disease processes and clinical competency. Candidate must possess excellent communication (verbal and written), interpersonal, collaboration and relationship-building skills. Strong critical thinking skills and ability to integrate knowledge is necessary. Prioritization and organizational skills required. Must exhibit the ability to educate members of the healthcare team about clinical documentation. Individual must demonstrate data quality and integrity skills. To perform this job successfully, an individual should have strong working knowledge of word processing software, spreadsheet software and reporting software. Also, experience working with encoder software, clinical documentation improvement software and the electronic medical record is preferred English is required for both verbal and written communication. Ability to communicate effectively at a high level is required.
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0 Claims Quality Audit Supervisor jobs found in Roswell, NM area