DME Supervisor

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $85k - $110k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 $10M Series A - Machinify on 2018-10

Healthcare • Consulting • Logistics

Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries.

📋 Description

• Manage staff and operational results for a remote team of nurses and other audit roles • Perform a limited volume of clinical audits to maintain subject matter expertise and support business needs • Perform audit quality assurance reviews and contribute to resolving quality review rebuttals • Perform appeals review or activity as needed • Identify and recommend cost savings and outcome-improvement opportunities • Ensure staff adherence to medical review guidelines and training requirements • Support audit management and segment specialists with new concept implementation • Support needs assessments and capacity planning • Monitor assigned business inventory, identify potential backlogs, and align resources to meet business needs and SLAs • Oversee and review audit determinations for consistent decision-making • Collaborate with departments to resolve operational problems • Manage staffing levels and ensure auditors have required tools and resources • Supervise daily activities of clinical audit staff • Provide audit guidance, identify trends, and present solutions • Provide performance reports, coaching, and constructive feedback • Manage team time and attendance and complete performance reviews • Conduct regular team meetings and resolve conflicts • Escalate employee matters and collaborate with management, HR, and the People Team • Provide operational and staff activity updates to management • Participate in department and client-facing meetings, research issues, present findings and solutions, and/or provide training • Monitor third-party/subcontractor inventory and activity as needed • Serve as subject matter expert for assigned business segments • Maintain current knowledge of medical practice, technology, regulations, legislation, and business trends • Develop or support training materials, tools, and best practices • Identify training needs and support training for new and existing audit staff • Foster continuous improvement, open communication, information sharing, and optimized business results • Lead by example and comply with company policies, government regulations, and law • Perform other related duties as assigned

🎯 Requirements

• Current active unrestricted Nursing license in good standing required • Must not be sanctioned or excluded from the Medicare program by OIG • 3+ years diverse nursing experience providing direct care in an inpatient or outpatient setting • 2+ years performing medical record audits in a provider setting or payer setting for a health insurance company • 5+ years in health care claims demonstrating expertise in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG, and medical billing experience for an insurance company or hospital required • Candidates with less than 5 years of experience may be considered based upon demonstrated skills, formal training, and other relevant experience • 3+ years relevant supervisory or leadership experience in a similar business environment preferred • Experience managing remote staff is a plus • Medical coding certification is a plus • Strong knowledge of medical documentation requirements and CMS, Medicaid, and/or Commercial insurance programs • Experience with CPT/HCPCS/ICD-9/ICD-10/MS-DRG coding • Proficiency with CMS-1500/UB-04 forms • Working knowledge of encoder • Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines, Milliman, or InterQual • Ability to review, analyze, and research medical billing, documentation, and coding issues • Reimbursement policy and/or claims software analyst experience • Familiarity with interpreting electronic medical records (EHR) • Experience developing, documenting, and implementing processes and procedures • Experience in inventory management, resource planning, and report generation • Strong analytical, technical, critical-thinking, organization, prioritization, time-management, editing, proofreading, and decision-making skills • Experience leading, motivating, coaching, and developing teams • Intermediate Excel skills and proficiency with MS Office, application reporting tools, and case management systems/tools • Ability to learn and adapt to new systems and tools • Ability to work independently in a remote setting with minimum supervision • Ability to work flexibly in a fast-paced environment with changing priorities

🏖️ Benefits

• Equal employment opportunity • Reasonable accommodation during the application or recruitment process • Employment at will • E-Verify participation as required by applicable law