Finance Clinical Appeals Coordinator - Business Operations Center - Independence, OH

Finance Clinical Appeals Coordinator - Business Operations Center - Independence, OH -

Job Abstract:
Helps the income cycle by finishing retrospective evaluations to make sure medical necessity standards is met. Assures enterprise actions conform to regulatory necessities and identifies tendencies, course of alternatives to maximise reimbursement. Helps coverage improvement and interdisciplinary schooling.

Obligations:
Payer Denial Administration Nurse: Helps the denial and attraction course of inside the Payer Denial Administration division. Coordinates denial attraction comply with-up and analyzes offered medical documentation, standards software, doctor advisor enter, completes evaluation of the medical report and formulates the attraction letter. Participates within the software of medical necessity assessment and makes use of standards software (MCG and/or InterQual). Ensures compliance requirements are met with required parts and offers suggestions to the management staff. Relays doctor, nursing and care supervisor documentation enchancment alternatives to help with attraction protection course of.
RAC /Payer Audit Nurse: Helps denials, appeals, inside the Payer Audit division. Conducts audit evaluations to guarantee actions conform to regulatory necessities. Coordinates denial attraction comply with-up; analyzes offered medical documentation, standards software consequence, doctor advisor enter, completes evaluate of the medical report and formulates the attraction letter. Professional within the software of medical necessity assessment standards software (MCG and/or InterQual). Helps the event of efficiency enchancment methods in response to recognized patterns and developments involving authorities payers.
Cost Seize Nurse: Helps the Statement cost seize course of for the enterprise. Works with a multi-disciplinary workforce to guage and enhance the cost seize course of. Evaluations the medical document for Remark instances to make sure correct and well timed billing of statement hours and applicable fees. Makes use of the appliance of medical necessity evaluation standards software (MCG and/or InterQual). Works cooperatively to assessment, consider and enhance the cost seize course of to determine an enterprise uniform course of. Helps improvement of efficiency enchancment methods in response to recognized patterns and developments.
Different duties as assigned.

Schooling:
Bachelor of Science in Nursing or Bachelor’s diploma in a associated area most popular.

Certifications:
Licensed Registered Nurse (RN) within the state of Ohio, BSN most popular.
Skilled certification as a Case Supervisor most popular.
Experience with InterQual and Milliman illness management ideologies most popular.

Complexity of Work:
Requires crucial considering expertise, decisive judgment and the power to work with minimal supervision.
Should have the ability to work in a hectic surroundings and take applicable motion.

Work Expertise:
Minimal three-5 years Care Administration or Utilization expertise which would come with acute med/surg expertise required.
Experience with InterQual and Milliman illness management ideologies is most popular.
In-depth familiarity with third social gathering billing requirement and laws, billing documentation necessities most popular. Understanding of CPT and HCPCS coding tips most popular.

Bodily Necessities:
Guide dexterity to function workplace gear.
Requires prolonged durations of standing, strolling, sitting and carrying as much as 25 kilos.
Regular or corrected imaginative and prescient and listening to to regular vary.

Private Protecting Gear:
Follows normal precautions utilizing private protecting gear as required.

CLICK HERE TO APPLY

Tweet

Subscribe to receive free email updates: