RN Billing Specialist - Denials

Manages appropriate cost-effective utilization of services across the care continuum. Demonstrates responsiveness to changing health care needs of the patient population and changes in insurance contracts. Performs concurrent and retrospective clinical reviews on all the contracted and emergent non-contracted patient encounters. Holds key position as an interdisciplinary team member for discharge planning needs. Identifies clinical quality indicator adverse events and documents this data in Canopy. Presents Medicare Important Message and Detailed Notice of Discharge forms to the Medicare beneficiaries per Federal regulation requirements.

Graduate of an accredited school of professional nursing or a school accepted for candidacy status from an accrediting body.
MSN level preparedness preferred
Must meet core training requirements

Minimum of five (5) years varied clinical experience in an acute care facility or insurance related position.

Has a broad understanding of Utilization Management concepts that included, but are not limited to: Traditional Medicare and Medicaid Regulations and Requirements, IM Form, Detailed NONC, HINN Letters, Notification Letter to Medicare recipients of patient admission status, Inpatient only Procedure List for -Medicare recipients, Knowledge of Payor Types, Worker’s Compensation, Veteran’s administration, DRG reimbursement, PPO, POS, HMO, Medicare Open Plans, Carve out for Services, Indigent Plans, Institutional Accounts, ICD-9, CPT, and HCPC, Co-Morbidity and Case Mix Indexes, Specific Insurance Plan Policies and Procedures, Experimental and non-efficacious statements

IND 123

Job Types: Full-time, Permanent

Pay: $30.00 - $45.00 per hour

Benefits:

• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Physical setting:

• Acute care

Standard shift:

• Day shift

Weekly schedule:

• Monday to Friday
• No weekends

Application Question(s):

• Do you have a valid RN License in Ohio?
• What is your highest level of Education, ie., Bachelors, Master's etc.

Experience:

• Clinical experience in Acute Care or Insurance Related: 5 years (Preferred)

Work Location: In person