Itemization Review 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.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Maintain accurate, current data and analytics to support informed decision-making and reliable outcomes
• Manage and track client appeals as required
• Oversee the file assignment process and continuously monitor nurse workloads and queues
• Ensure daily prioritization of all claims is clearly understood and executed
• Prepare and maintain monthly metrics and reporting
• Demonstrate working knowledge of CERIS systems and databases
• Lead and support the team with minimal managerial oversight
• Foster a collaborative and positive work environment through effective team leadership
• Ensure strict adherence to HIPAA compliance standards
• Additional duties as assigned

KNOWLEDGE & SKILLS:

• Comprehensive knowledge of departmental policies and procedures related to Itemization Review
• Advanced understanding of client payment policies as they apply to reviews
• Familiarity with quality control processes
• Strong organizational, strategic thinking, and critical analysis skills
• Excellent written and verbal communication skills
• Ability to manage high-pressure situations and adapt to changing priorities
• Proven leadership, problem-solving, and analytical capabilities
• Ability to work both independently and collaboratively
• Skilled in organizing and facilitating monthly team meetings with a focus on training and development
• Proficiency in MedCheck, MedCheck Select, CareMC, Tableau, UKGPro, departmental policies and procedures, and Microsoft Office Suite (including Excel, Outlook, and Teams)

EDUCATION & EXPERIENCE:

• Must maintain current licensure as a Registered Nurse (RN) 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.
• At least 3 years of experience in a hospital supervisor or manager role
• Associate Degree in Nursing or higher
• Minimum of 3 years’ experience in LIBR preferred
• Experience in medical bill auditing preferred
• Knowledge of ICD-10, DRG and coding preferred

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $70,276 – $116,942

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CERIS:

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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