DME Supervisor

Machinify
United States
Workplace: RemoteFull timeUSD 85,000 - 110,000 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Skills: ["Leadership","Communication","Analytical thinking","Time management","Collaboration"]

Oversee remote clinical audit teams to ensure medical review determinations are accurate, consistent, and aligned with program guidelines. Perform limited-volume clinical audits and QA reviews, resolve quality rebuttals, and support appeals as needed. Lead staffing and capacity planning, monitor timelines and SLAs, review determinations for consistency, and provide coaching, progress reporting, and performance management. Serve as a segment subject matter expert and drive continuous improvements and cost-saving opportunities.

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FursaFursa
Machinify
Machinify
2 days ago

DME Supervisor

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Source: Company careers pageValidated by: Fursa AI
Last checked: 13 hours agoStatus: Live

Job Summary

Oversee remote clinical audit teams to ensure medical review determinations are accurate, consistent, and aligned with program guidelines. Perform limited-volume clinical audits and QA reviews, resolve quality rebuttals, and support appeals as needed. Lead staffing and capacity planning, monitor timelines and SLAs, review determinations for consistency, and provide coaching, progress reporting, and performance management. Serve as a segment subject matter expert and drive continuous improvements and cost-saving opportunities.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Supervise daily activities of clinical audit staff, including performance reviews, coaching, and conducting team meetings.
  • •Perform limited-volume clinical audits and audit QA reviews as needed; resolve quality review rebuttals and support appeals when required.
  • •Manage staffing and operational results through needs assessments, capacity planning, and monitoring timelines/SLAs, including inventory management.
  • •Provide production and quality performance progress reports to management and ensure adherence to medical review guidelines and training requirements.
  • •Oversee and review audit determinations to ensure consistency; collaborate with other departments to resolve operational problems and identify cost-saving opportunities.

Pay and Benefits

Salary: USD 85,000 - 110,000 annually

Key Requirements

  • •Current active unrestricted Nursing license in good standing and not sanctioned or excluded from Medicare by OIG.
  • •5+ years in health care claims with expertise in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG, and medical billing for an insurance company or hospital.
  • •2+ years performing medical record audits in a provider setting or in a payer setting for a health insurance company.
  • •3+ years diverse nursing experience providing direct care in an inpatient or outpatient setting.
  • •3+ years relevant supervisory or leadership experience; experience managing remote staff preferred.
Experience:HealthcareHealthcare claimsMedical billingClinical auditingPayerProvider
Skills:LeadershipCommunicationAnalytical thinkingTime managementCollaboration
Licenses:Unrestricted nursing license
Certifications:Medical coding certification
Languages:English
Tech Stack:CMSMedicaidCommercial insurance programsCMS medical documentationCPTHCPCSICD-9ICD-10DRGMCS-1500UB-04EncoderUtilization management systemsMedical Coverage GuidelinesMillimanInterQualEHRMS OfficeExcelCase management

Company Brief

Machinify
Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.
Industry: Industrial Automation
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