REGISTERED NURSE
3 weeks ago
Registered Nurse who is responsible for performing Audits and Clinical Appeals as related to medical necessity, appropriateness of patient status and providing education and guidance to practitioners and other team members.
Essential Functions
* Identifies accounts and actions to secure compliance for Medicare and Medicaid.
* Prepares and processes appeals on denied accounts in a timely manner. This includes an assessment of the account, strategy plan and written communication designated by governmental agents as outlined for the appeal process.
* Performs audits as outlined by governmental guidelines for charges and billing accuracy.
* Functions as a liaison with governmental agencies to facilitate the audit process as needed through written and verbal communication.
* Functions as a resource for education for Charlotte Metro facilities and regional facilities as outlined.
* Interfaces and collaborates with Clinical Care Management and Coding to ensure appropriate level of care has been met and billing is compliant with both.
* Develops and presents educational materials related to issues identified.
* Communicates with internal and external customers in relation to regulatory guidance.
* Maintains current knowledge of Interqual, Medicare and Medicaid guidelines.
Physical Requirements
Environment requires the ability to concentrate, analyze information and sit for long periods of time. Frequent interruptions require flexibility in performance of duties. Ability to communicate well and comfort in speaking among groups. Each teammate is responsible for working in a safe manner. Requires some travel and use of personal vehicle.
Education, Experience and Certifications
Graduate of an accredited program of Nursing required. Current NC RN license required. 1 - 3 years of hospital nursing experience in various clinical areas. BSN preferred. BLS required per policy guidelines. Demonstrates analytical ability, initiative and resourcefulness. Microsoft Office experience preferred. Excellent planning and organizational skills. Excellent verbal and written communication skills.
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