About the job
As a Nurse Audit Supervisor, you will leverage your expertise to lead and mentor our Nurse Audit team. In this pivotal role, you will:
• Supervise and provide guidance to the Nurse Audit team, serving as a vital resource for both professional and support staff.
• Coordinate team activities aimed at fulfilling business objectives while ensuring that our members receive medically necessary, cost-effective, and high-quality care.
• Oversee the appropriateness of medical payments, ensuring alignment with contract provisions, coding accuracy, and policy compliance.
Key Competencies and Knowledge:
• In-depth understanding of ICD-10 coding and claims reimbursement processes.
• Proven ability to prioritize tasks for the team and manage work outputs and timelines effectively.
• Strong verbal and written communication skills, capable of engaging with members, employers, and provider groups.
• Leadership skills to effectively develop and guide a team, including remote or off-site employees.
• Experienced in identifying and resolving complex issues and challenges.
• Familiar with current trends and technologies in the health insurance industry.
• Expertise in clinical utilization management and care management practices.
• Ability to implement best practices and adhere to designated standards.
Qualifications:
To excel in this role, the ideal candidate will possess:
• A Bachelor’s degree in Nursing or a related field, with a minimum of 3 years of leadership experience and 5 years of clinical experience, or an equivalent combination of education and experience.
Licensing and Certifications:
• Must hold a valid Registered Nurse Licensure in WA, OR, UT, or ID, with at least 3 years of full-time equivalent direct clinical care experience.
• Preference will be given to candidates with AHIMA credentials (RHIT/RHIA/CCS).
Ideal Candidate:
The perfect candidate will have supervisory experience in a clinical setting within a health insurance plan, alongside auditing and potentially coding expertise.