Clinical Appeals Nurse - Patient Financial Services - FT Days at Careers
Job Description & Salary Range
UC Title: Reimbursement HC Analyst 4Position Number: 10007016Reports to: Dir, Patient Financial SvcsWorking Title: Reimbursement HC Analyst 4Cost Center: Patient Financial Services (8550)Bargaining Unit: NoneFLSA: ExemptJob Code: 6768Date Created: 11/04/2019Shift: Day ShiftHours: 40.00
Position Summary: Incumbent is responsible for planning, directing and overseeing all aspects of Clinical Appeals and Charge Audits. The Clinical Appeal Nurse will be in charge of initiating the appeal process and developing victorious appeal letters to support medical necessity or level of care. Provides necessary training and education to staff involved in processes and ensures standards complies with federal, state and other regulatory agency rules and regulations. Works with Care Management leadership and Physician Advisors to ensure knowledge of denial to improve impactful areas. Actively participates on organizational performance improvement projects. Serves as a role model and resource to colleagues, staff and others.
Rate Minimum $68,500.00 Maximum $140,200.00
Required Qualifications: 3 year experience with InterQual/MCG Guidelines required3 years' working in an Acute Hospital Utilization Management, Concurrent Review Process or Care Management areaAbility to establish and maintain effective working relationships across the HealthSystemAbility to maintain a work pace appropriate to the workloadBachelor of Science in NursingDemonstrated ability to lead change and effectively manage conflictExcellent analytical skillsExcellent working knowledge of desktop computer productivity toolsExcellent written and verbal communication skills in EnglishExperience generating victorious Appeal LettersKnowledge of CMS, DHCS, Joint Commission, CADP, and other regulatory and compliance requirementsMust demonstrate customer service skills appropriate to the jobMust possess the skill, knowledge and abilities essential to the successful performance of assigned dutiesOutstanding interpersonal skills; ability to interact effectively at all levels of the organizationProficiency in Microsoft Office suiteStrong knowledge and understanding of ICD-10 and CPT codes
Preferred Qualifications: Knowledge of University and Medical Center organizations, policies, procedures and formsKnowledge of patient safety strategiesKnowledge of quality improvement methodologies
Physical, Mental & Environmental Demands:To comply with the Rehabilitation Act of 1973 the essential physical, mental and environmental requirements for this job are listed below. These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all of the functions of the job with or without reasonable accommodation.
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