Texas Licensed Clinical Review Supervisor

Job Summary

A company is looking for a Clinical Review Supervisor.

Key Responsibilities

• Supervises daily activities of the DRG Clinical Auditors and ensures quality of diagnosis and procedure codes
• Completes DRG audits and provides clinical/policy/regulatory support for coding determinations
• Holds auditors accountable for quotas and accuracy rates while assisting with team coverage as needed

Required Qualifications, Training, and Education

• N./L.V.N. preferred; CCS or CIC required with DRG auditing experience
• Proficient in Medicare, CMS guidelines, and ICD-10 coding guidelines
• Minimum of 3-5 years of inpatient/DRG auditing experience in a hospital or payer setting
• At least 2 years of supervisory experience with clinical auditors
• Demonstrated knowledge of ICD-10-CM, PCS codes, and payer rules and regulations