Quality Control Nurse II

2 weeks ago

Fort Worth TX United States CERiS Full time
This position is responsible for overseeing the quality and integrity of the itemized bill review proprietary database. This includes managing and maintaining data and data sets to ensure the accuracy, completeness and defensibility of the database. Helps ensure the database meets the needs of the organization. This position also includes some maintenance and reporting functions as well as support for the Data Capture, Quality Control and Medical Review departments as it relates to data.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Manage and maintain the database system to ensure data accuracy, completeness and defensibility.
  • Monitor and analyze data while identifying and resolving issues as needed.
  • Accurately match hospital billing data within CERIS's proprietary universal chargemaster database.
  • Verify accuracy of all matches performed by the auto match engine.
  • Add appropriate description modifiers to clarify data and support accurate matching.
  • Recognize and reorganize specific items and/or groups of items for data clean-up and quality control.
  • Determine need and help create new data groupings by monitoring unmatched data, FDA news, CPT updates, other alerts, as well as internal communication from medical review staff.
  • Maintain database structure and organization.
  • Assist staff with production issues and questions by having a solid understanding of the business process specifically related to data capture, quality control and medical review.
  • Assist in preparing database for quarterly updates.
  • Assist development team with testing of application and database changes. Provide input and recommendations for design and functionality of current and future releases.
  • Identify discrepancies in data/data sets and make necessary corrections including documentation of specific chargemaster procedures.
  • Understand variable billing practices in relation to nursing knowledge and experience in order to make accurate decisions.
  • Comply with HIPAA regulations.
  • Additional duties and responsibilities as assigned by management.

KNOWLEDGE & SKILLS:

  • Advanced computer skills required.
  • Exceptional attention to detail.
  • Must possess advanced organizational, strategic and critical thinking skills.
  • Excellent verbal and written communication skills.
  • Ability to easily handle stressful situations and changing priorities.
  • Ability to think and work independently.

EDUCATION & SKILLS:

  • Associate Degree in Nursing or higher required.
  • Must maintain current licensure as a Registered Nurse in the state of employment.
  • Minimum of 5 years' experience in acute medical setting such as O.R., ER, ICU, Oncology or MedSurg as an RN highly preferred.
  • Prefer experience with hospital billing including UB-04's, itemized bills, revenue codes and CPT/HCPCS codes.
  • Experience or knowledge of SQL or other relational databases is a plus.

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $58,282 - $93,870

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

About CERIS

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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