DME Supervisor

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

The Medical Review Audit Supervisor - Clinical leverages their nursing background, deep knowledge of clinical review, and experience leading others to manage staff and operational results for a remote team of nurses and other audit roles, performing clinical review audits. The Supervisor will leverage first-hand experience and knowledge of claims auditing for supporting management with strategy activities such as needs assessments, capacity planning, and ensuring required staffing levels and productivity & quality standards are being achieved consistently.

Key Responsibilities to include:

-
Regularly performs limited volume of clinical audits to maintain subject matter expertise, and additionally as needed to support business needs.

-
Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects.

-
Contributes to the resolution of quality review rebuttals.

-
May perform appeals review/activity to supplement Appeals team, based upon business need.

-
Actively identifies and recommends opportunities for cost savings and improving outcomes that can have a direct impact to the company's profitability.

-
Effectively ensures adherence to medical review guidelines and training requirements of staff.

-
Supports audit management and segment specialists with activities for new concept implementation

-
Supports management with needs assessments and capacity planning

-
Monitor and manage inventory of assigned business to ensure timelines are met.

-
Use data, reports and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs.

-
Oversee and review audit determinations to ensure consistency in decision-making.

-
Collaborate with other departments to resolve operational problems.

-
Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing levels necessary to achieve business objectives.

-
Provides support as needed to ensure auditors are equipped with tools and resources required to perform audits.

-
Supervise daily activities of clinical audit staff that may include both salaried exempt and hourly employees.

-
Provide audit guidance to medical review staff; identify trends and present solutions.

-
Routinely provides production and quality performance-based progress reports, coaching, and constructive feedback to staff.

-
Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures.

-
Collaborates with The People Team for applicable corrective action as applicable.

-
Complete and conduct performance reviews for assigned staff.

-
Conduct team meetings with direct reports on a regular basis.

-
Provide leadership to team members, provide solutions, and resolve conflicts.

-
Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee matters.

-
Provide reporting and updates to management as required and appropriate for operational and staff activity and results.

-
Participates in and contributes to applicable department meetings.

-
May participate to client-facing meetings; research and analyze issues; present findings and solutions; and/or provider training.

-