Clinical Review and Coding Supervisor
Job Description
Job Description
NELC is one of the fastest growing home infusion therapy services companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, we encourage you to apply!
New England Life Care currently has an opening for a Clinical Review and Coding Supervisor. This is a Work From Home position, but occasional travel to branch locations may be needed for training. This is a 40 hour, salaried, Monday – Friday, 8AM – 5PM Supervisory Position.
**Although this is a remote position, we are only hiring in the following states: Massachusetts, New Hampshire, and Maine.**
Benefits:
- Health insurance
- Dental insurance
- Vision insurance
- Generous employer-matched 403b savings program
- Company paid: Life insurance, Short- and long-term disability insurance
- Discretionary PTO
- And much more!
Primary Responsibilities:
- Works closely with the Insurance and Authorization Manager in the establishment, achievement and ongoing monitoring of department goals and objectives as they relate to reimbursement, compliance and communication for patient accounts.
- Assists in training new staff by providing documentation needed, support, and one-on-one time for questions.
- Assists in auditing new and existing staff and maintaining audit records
- Works closely with the Insurance and Authorization Manager to provide timely, constructive feedback, coaching and progressive discipline to employees, ensuring that these conversations are appropriately documented in the employees’ HR record.
- Routinely updates department documentation as new payers are seen, processes are changed or updated, and new therapies begin.
- Communicate effectively with internal and external customers regarding new referrals and ongoing patient issues
- Monitors and adjust daily workload to ensure tasks are processed within company guidelines.
- Routinely performs quarterly reviews with all direct support staff and sets department and career goals.
- Monitor PTO requests for the team, as well as review and approve timecards for direct report staff.
- Coordinates staffing for special projects and works as back-up when staff cannot attend or address issues regarding special projects
- Work with the Insurance and Authorization Manager to implement, test, and roll out new technology, ie. EMR, system enhancements, new software.
- Maintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and payer contracts to ensure compliance.
- Works collaboratively with the Liaison/Care Coordination team to ensure efficient discharge, while directing newer Liaisons with clinical review process.
- Work collaboratively with the Manager to screen potential employees through ADP, review phone screens and set up and conduct interviews for potential employees.
- Meet with staff quarterly to focus on professional development and complete staff
- Complete debt analysis each month to review department write-offs and identify trends and opportunities for improvement.
- Work with Insurance and Authorization Manager, Business development and Liaisons to identify opportunities for education to referral sources and internal and external teams,
- Support the Coding Team as needed in communicating with medical providers, patients, and insurance companies to obtain proper clinical documentation
- Supporting the Coding Team by assuring patient compliance with payor regulations regarding appropriate clinical documentation and insurance forms
- Assign clinically appropriate ICD 10 codes to patient account based off provider documentation.
Educational / Professional Requirements:
- MA or LPN required
- Minimum of two (2) years of supervisory experience or equivalent leadership experience required.
- ICD-10 Certification
- Certified Professional Coding through AAPC or AHIMA Required (Or within one year of being hired)
- Minimum of (4) years of healthcare experience required.
Regulatory Requirements:
- Working knowledge of federal / state fraud and abuse laws required.
- Knowledge of HIPAA Privacy and Security Regulations is preferred.
''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
Monday through Friday from 8:00am until 5:00pm