Company
Compassus
Position Summary
The Pre-Claim Review (PCR) Supervisor oversees and manages the Pre-Claim Review process for all Medicare patients to ensure compliance with CMS guidelines, Home Health Conditions of Participation (CoPs), and Compassus policies. This role provides leadership and operational oversight to the PCR team, ensuring the accurate and timely submission of requests and preventing delays in care delivery or reimbursement. The Supervisor serves as a key liaison between clinical staff, physicians, billing, compliance, and other stakeholders to promote efficiency, regulatory adherence, and high-quality documentation supporting the required level of care.
Position Specific Responsibilities
- Supervise and lead the PCR staff, including daily workflow, performance monitoring, and professional development.
- Review and approve PCR submissions for accuracy, completeness, and compliance with Medicare and company standards.
- Monitor submission timeliness and outcomes to ensure full compliance with CMS requirements.
- Collaborate with clinical, intake, and billing teams to ensure documentation supports medical necessity and eligibility criteria.
- Provide education and coaching to clinical and regional leaders on documentation requirements and common deficiencies identified through PCR.
- Develop, track, and report on key performance indicators (KPIs), such as denial rates, turnaround times, and recertification approval trends.
- Serve as the primary contact for CMS reviewers and manage communications related to additional information requests or clarifications.
- Partner with the revenue cycle team on payer appeals and resubmissions when PCR requests are denied.
- Identify process gaps and partner with leadership to implement improvements that enhance efficiency and compliance.
- Ensure PCR practices align with Home Health CoPs, Medicare regulations, and Compassus policies.
- Participate in internal audits and external surveys, preparing documentation and corrective action plans as needed.
Education And/or Experience
- Graduate of an accredited nursing program (Associate’s degree or diploma in Nursing required; Bachelor of Science in Nursing (BSN) preferred).
- Minimum of three (3) years of Home Health experience, including at least one (1) year in a supervisory, compliance, or quality review capacity.
Skills
- Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage.
- Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications.
- Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces integrated healthcare at home philosophy. Strong working knowledge of Medicare regulations, CMS Pre-Claim Review requirements, and Home Health CoPs. Proven leadership, organizational, and communication skills. Ability to work effectively across multiple departments and with external reviewers. Proficiency in EMR systems and Microsoft Office Suite. Demonstrated ability to analyze data, prepare reports, and implement process improvements.
Certifications, Licenses, and Registrations
- Active Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in good standing.
Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 25 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization.
At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Build a Rewarding Career with Compassus
At Compassus, we care for our team members as much as we care for our patients and their families. Through our Care for Who I Am culture, we show compassion, respect, and appreciation for every individual. Embark on a career that cares for you while you care for others.
Your Career Journey Matters
We’re dedicated to helping you grow and succeed. Whether you’re pursuing leadership roles, specialized training, or exploring new career paths, we provide the tools and support you need to thrive.
The Compassus Advantage
- Meaningful Work: Make an impact every day by honoring the quality of life of our patients, supporting them and their families with compassion, and creating moments that truly matter.
- Career Development: Access leadership pathways, mentorship, and personalized professional development.
- Innovation Meets Compassion: Collaborate with a supportive team using the latest tools and technologies to deliver exceptional care.
- Enhanced Benefits: Enjoy competitive pay, flexible time off, tuition reimbursement, and wellness programs designed for your well-being.
- Recognition and Support: Be celebrated for your contributions through recognition programs that honor your dedication.
- A Culture of Belonging: Thrive in a culture where you can be your authentic self, valued for your unique contributions and supported in a community that embraces diversity and inclusion.
Ready to Join?
At Compassus, your career is more than a job—it’s an opportunity to make a lasting impact. Take the next step and join a team that empowers you to grow, innovate, and thrive.
