Quality Management Nurse Consultant
CVS Health
Insurance Supervisor
Revco Solutions
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $58,000 per year
Job Level
Mid-LevelSenior
About the role
- Oversee daily operations of billing and insurance follow-up teams.
- Execute billing and follow-up plans, monitor department reports, and track user productivity.
- Manage client communications, including project updates, billing system support, and service implementations.
- Lead internal and external meetings to discuss project deliverables and updates with key stakeholders.
- Resolve account balances and assist with complex billing or denial issues.
- Monitor and resolve inappropriate denials, underpayments, and overpayments.
- Stay current with payer guidelines, regulations, and industry best practices through webinars, seminars, and research.
- Identify billing system issues and assist in system updates and process improvement initiatives.
- Respond to audits (e.g., RAC, MIC, ADR) and support the appeals process.
- Create and maintain tracking tools for interdepartmental communication and reporting.
- Provide coaching and support to staff members to meet quality and productivity standards.
- Manage staffing needs, assist with hiring decisions, and ensure time and attendance compliance.
- Maintain effective working relationships with clients, internal teams, and external stakeholders.
- Ensure HIPAA compliance and maintain patient confidentiality at all times.
- Act as a liaison between Management, Supervisors, and Staff to promote department success.
- Lead initiatives aimed at reducing payer rejections and denial rates.
- Support revenue cycle projects and provide feedback on operational effectiveness.
Requirements
- High School Diploma required; Associate’s or Bachelor’s degree preferred.
- 5-7 years of experience in healthcare revenue cycle operations.
- 3 years of direct management or supervisory experience.
- Certification preferred (e.g., AAHAM, HFMA, NAHAM); Project Management certifications a plus.
- Strong knowledge of patient accounting systems, EHRs, billing forms (UB04, HCFA 1500), and CPT/HCPCS/ICD-10 coding.
- Demonstrated experience in appeals, denial management, and payer regulations.
- Advanced knowledge of billing processes and insurance collection standards.
- Excellent communication skills with the ability to present updates to senior leadership and clients.
- Proficient in Microsoft Office and familiar with payer portals and billing platforms.
- Strong analytical, problem-solving, and conflict resolution skills.
- Ability to lead teams, manage multiple projects, and meet deadlines in a fast-paced environment.
Benefits
- Insurance
- 401k match
- PTO
- Paid holidays
- Referral bonuses
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
billing processesinsurance collection standardspatient accounting systemsEHRsCPT codingHCPCS codingICD-10 codingappeals managementdenial managementproject management
Soft skills
communication skillsanalytical skillsproblem-solving skillsconflict resolution skillsleadershipteam managementorganizational skillsinterpersonal skillscoachingtime management
Certifications
AAHAMHFMANAHAMProject Management certification
