Supervisor, Clinical Review (LMHC-LPC-LMFT-LIMHP-LCSW)

Position Purpose: Oversee audits to identify inappropriate billing practices and determine medical necessity. Supervise daily activities and work load for clinical review staff. Review audit reports to ensure accuracy and completeness Review medical records to determine if bills submitted by providers match the supporting documentation Present audit results to Corporate and Health Plan senior managements and individual providers Manage staff work load based on volume of prepay and retrospective audits to ensure reviews are completed in a timely manner Identify and implement improvement opportunities to ensure effective and efficient audit processes Assist with defining medical policy as appropriate Perform cost savings analysis and meet with Medical Director(s) to validate medical decisions and track cost savings based on clinical denialsQualifications:Education/Experience: Bachelor's degree in Nursing, related field, or equivalent experience. RN or LPN preferred. 4+ years medical coding experience. Working knowledge of CPT code billing, medical terminology and research techniques. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects. Clinical experience in a hospital, clinic setting, emergency room and/or physician office preferred.License/Certification: LMHC, LPC, LMFT, LIMHP, LCSW strongly preferredCentene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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