Supervisor, Outpatient Audit Operations

🕒 Junho 16

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

⚙️ Operações

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Machinify

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

⚕️ Seguro de Saúde

🤖 Inteligência Artificial

☁️ SaaS

💰 $10.000.000 Series A - Machinify em 2018-10

Healthcare Insurance • Artificial Intelligence • SaaS

A Machinify é uma empresa de plataforma e serviços de IA focada em saúde que transforma pagamentos e a integridade de pagamentos no setor. Seu sistema operacional de IA unifica reivindicações, prontuários médicos, contratos e políticas, utilizando modelos fundamentais e agentes específicos de tarefas para automatizar e aprimorar a codificação, precisão de pagamentos, recuperações e prevenção de custos. A Machinify atende planos de saúde (incluindo 18 dos 20 maiores), oferece implantações internalizadas, híbridas ou totalmente gerenciadas e enfatiza resultados mensuráveis — relatando mais de 85 clientes, 270 milhões de vidas cobertas e mais de 6 bilhões de dólares em prevenção de custos e recuperações anuais.

Descrição

• Oversees and reviews audit determinations to ensure consistency in APC/APG grouping decisions, OPPS packaging interpretation, and outpatient coding policy application. • Uses data, reports, and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs. • Effectively contributes to the development of medical review guidelines, coding education materials, and outpatient-specific training content. • Supports audit management and subject matter experts with new concept implementation and ongoing maintenance of outpatient medical review guidelines, including annual OPPS updates and CMS rule changes. • Accountable for achieving established productivity, quality, turnaround time, and employee engagement goals for the assigned team. • Ensures audit activities are performed in accordance with applicable regulatory requirements, client contracts, organizational policies, and industry standards. • Identifies process inefficiencies and implements solutions to improve accuracy, consistency, and productivity. • Monitors audit quality performance and collaborates with Quality Assurance and leadership teams to ensure consistency, accuracy, and defensibility of audit findings.

🎯 Requisitos

• One of the following active certifications: RHIA, RHIT, CCS, CPC, COC • 7+ years of facility outpatient coding experience in a hospital or health system setting, with demonstrated expertise in APC grouping and OPPS payment rules. • 2+ years of outpatient facility coding audit, performing pre-payment and post-payment reimbursement reviews, or payment integrity experience in a provider, payer, or audit vendor environment. • 3+ years of relevant management or leadership experience in a similar business environment (preferably experience overseeing remote coding audit staff). • Experience reviewing outpatient facility claims for coding accuracy and applying APG reimbursement guidelines during audit and overpayment identification activities. • Demonstrated success managing productivity, quality, turnaround time, and workforce performance metrics in a remote audit environment.

🏖️ Benefícios

• PTO, Paid Holidays, and Volunteer Days • Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts • Tuition Reimbursement • Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave. • Remote and hybrid work options