Supervisor Clinical Review

Are you looking for a career and not just a job in the Medical field? Virginia Cancer Specialists, an affiliate of McKesson Specialty Health and US Oncology, a leader in Cancer care, is seeking a Full Time Clinical Review Supervisor for our Administrative Office in Fairfax, Virginia. Associates degree in Healthcare required, licensed LPN or RN preferred. Medical insurance verification and authorization experience required.

SCOPE: Supervises the day to day clinical review operations in order to maximize the collection of medical services payments and reimbursements from patients, insurance carriers, financial aid, and guarantors. Supports and adheres to the US Oncology Compliance Program, to include Code of Ethics and Business Standards, and US Oncology's Shared Values.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

- Supervises the daily clinical review processes for patients to include insurance eligibility processes; charge processing; claim submission and processing; payment processing; collections and accounts receivable management; denial management; reporting of results and analysis; concurrent and retrospective auditing; proper coding; credentialing; customer services relative to revenue cycle; training and development relative to revenue cycle; analytics, and all other revenue cycle management activities. Resolves escalated and unique clinical review issues.

- Responsible for quality work, meeting deadlines, and adherence to the Practices Standard Operating Procedures (SOPs); regularly audits staffs work to ensure compliance.

- Monitors and assesses department metrics in order to refine processes and improve efficiencies. Guides individuals and teams toward priorities; clarifies roles and responsibilities of others; coordinates resources to meet objectives. Cascades goals down to staffs annual objectives.

- Champions new initiatives; acts as a catalyst of change and stimulates others to change; paves the way for needed changes; manages implementation effectively. Steps forward to address difficult issues; puts self on the line to deal with important problems; takes ownership and accountability.

- Conducts training of SOPs, systems, and metrics.

- Attracts high caliber people, accurately assesses strengths and development needs of employees; provides timely, specific feedback and helpful coaching; provides challenging assignments and opportunities for development. Responsible for interviewing, recommending hires, assessing performance, recommending salary changes, and progressive discipline. Enforces adherence to the Practice's and US Oncology policies.

-Other duties as requested or assigned.

MINIMUM QUALIFICATIONS: Associates degree in Healthcare, Business or equivalent OR four years Clinical Review experience required. LPN or RN preferred. Billing and coding experience preferred. Two years' experience managing, delegating, and following up on work priorities of others is strongly desired. Individual must have strong knowledge of medical insurance billing and collections with CPT, ICD9, and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc). Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint).

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.

Join us at Virginia Cancer Specialists!
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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