RN Denial Education Coordinator - Work from Home- Ohio - Full-Time - Days
Full Time
Miamisburg, OH 45342
Posted
Job description
Overview:
Responsibilities & Requirements:
The PFS RN Clinical Denial Education and Clinical Coordinator provides knowledge and support to clinical and revenue cycle teams. RN must have knowledge Milliman and InterQual criteria. RN will report to the patient financial services denial manager who in conjunction will collaborate with physicians, UM Nurses, and other members of the interdisciplinary team to educate and help implement improvements to front end processes with the goal of prevention of denials. Role will be responsible for supervising clinical denial team. Position will perform timely and accurate review, denial communications and construct appeals, including remaining current with regulatory, payer and internal requirements related to communication of trends and appropriate escalation to ensure appropriate resolution resulting in expected payment. The role will assist the patient financial services denial team by reviewing and updating denial procedures related to clinical payer policies. The position will also be responsible to help streamline current clinical denial workflow with the assistance of the denial’s manager. The coordinator will be responsible in working with vendors to provide guidance and ensure timely follow-up and established performance guidelines are met. Position participates in hiring and related personnel decisions, routine performance review evaluations, assisting in employee engagement initiatives, and training. Position will be responsible in monitoring reporting, analyzing data, and providing feedback to leadership. Role must maintain current knowledge of regulatory requirements regarding documentation and reimbursement from both contracted and federal payers. Coordinator will also be responsible for auditing appeals to ensure appropriateness and effectiveness. Must have strong written and verbal communication skills. Other duties as assigned.
Educational Requirements:
Knowledge of:
Skilled in:
Ability to:
Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.
Responsibilities & Requirements:
Job Summary:
The PFS RN Clinical Denial Education and Clinical Coordinator provides knowledge and support to clinical and revenue cycle teams. RN must have knowledge Milliman and InterQual criteria. RN will report to the patient financial services denial manager who in conjunction will collaborate with physicians, UM Nurses, and other members of the interdisciplinary team to educate and help implement improvements to front end processes with the goal of prevention of denials. Role will be responsible for supervising clinical denial team. Position will perform timely and accurate review, denial communications and construct appeals, including remaining current with regulatory, payer and internal requirements related to communication of trends and appropriate escalation to ensure appropriate resolution resulting in expected payment. The role will assist the patient financial services denial team by reviewing and updating denial procedures related to clinical payer policies. The position will also be responsible to help streamline current clinical denial workflow with the assistance of the denial’s manager. The coordinator will be responsible in working with vendors to provide guidance and ensure timely follow-up and established performance guidelines are met. Position participates in hiring and related personnel decisions, routine performance review evaluations, assisting in employee engagement initiatives, and training. Position will be responsible in monitoring reporting, analyzing data, and providing feedback to leadership. Role must maintain current knowledge of regulatory requirements regarding documentation and reimbursement from both contracted and federal payers. Coordinator will also be responsible for auditing appeals to ensure appropriateness and effectiveness. Must have strong written and verbal communication skills. Other duties as assigned.
Educational Requirements:
Licensed in the state of Ohio as a Registered Nurse- Graduate of an accredited school of nursing (NLN, ACEN, or CCNE) if they are a new graduate nurse
- Bachelor of Science in Nursing required.
- Minimum of 5 years clinical nursing experience. 3 years of case management or utilization management required. Nursing experience in the acute setting.
- Understanding of Medicare, Medicaid, and commercial payer regulations required.
- Experience in Microsoft tool
- Epic EMR Experience (Preferred)
- Relay Health/ePremis Experience (Preferred)
Knowledge of:
- Sound clinical knowledge base in acute care setting experience
- Experience with utilization management and care coordination
- Milliman and InterQual criteria is a must
- Experience with managed care contract terms and federal payer guidelines
- Experience in medical necessity guidelines and care coordination/case management functions
- Experience with hospital billing (UB04 form) and coding requirements
- Understanding of Revenue Cycle Processes
- In depth understanding of explanation of benefits (EOB's)
Skilled in:
- Effective in identifying and analyzing problems.
- Generates alternatives and identifies possible solutions.
- Development of procedures and assisting various teams and departments in process improvement related to denial prevention
- Notable client service, communication, presentation, and relationship building skills required.
- Resolution of claim appeals allowing timely submission
- Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards
- Ability to work independently as well as collaboratively within a team environment
- Excellent problem-solving skills
- Creative ability to escalation of appeals
- Excellent verbal, written and customer service communication skills.
Ability to:
- Strong analytical ability and critical thinking skills required
- Takes initiative · Creative problem-solving skills
- Ability to meet deadlines
- Personable, tactful, and cooperative
- Ability to work well with others
- Ability to clearly communicate with and establish and maintain good rapport with peers, physicians, hospital administration, nurses and other healthcare team members required
- Demonstrate integrity, objectivity, and thinking skills required
- Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, payor, customers, and co-worker Apply concepts, utilize sound judgment and work independently within a framework of guidelines required
- Function independently and as a team player in a fast-paced environment required.
colinoncars.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, colinoncars.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, colinoncars.com is the ideal place to find your next job.