Clinical Reviewer

3 weeks ago

Nashville, United States Ascension Health Full time

Details

* Department: Bariatric Support
* Schedule: Full Time, Day Shift, Monday-Friday
* Hospital: Saint Thomas Midtown
* Location: Nashville, TN

We are looking for a detail-oriented Metabolic and Bariatric Surgery Clinical Reviewer. This individual will maintain timely and accurate data entry to the Metabolic and Bariatric Surgical Accreditation and Quality Improvement Program (MBSAQIP). The ideal candidate will be highly organized, have excellent communication skills, and have knowledge of medical terminology.

Benefits

Paid time off (PTO)

Various health insurance options & wellness plans

Retirement benefits including employer match plans

Long-term & short-term disability

Employee assistance programs (EAP)

Parental leave & adoption assistance

Tuition reimbursement

Ways to give back to your community

* Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.

Responsibilities

Determine and verify insurance coverage and coordination of benefits from all sources for assigned area. Ensure proper adequate and timely billing to ensure prompt payment.

* Confirm insurance coverage.
* Determine necessity for pre-authorization and obtain authorization for scheduled procedures.
* Determine financial responsibility for services to be provided.
* Notify patients and/or practitioners of any services requested and/or referred that are not authorized by insurance.
* Communicate with patients and practitioners regarding financial responsibility and insurance coverage issues.
* Maintain detailed documentation in the patient account record of all billing activities.
* Maintain documentation of claims processed as part of the daily claims reconciliation process.

Requirements

Education:

* High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
* Note: Required professional licensure/certification can be used in lieu of education or experience, if applicable.



Additional Preferences

* Previous medical experience and knowledge of medical terminology
* Current Metabolic and Bariatric Surgery (MBS) Clinical Reviewer certification, or willingness to get certified upon hire

Why Join Our Team

Ascension Saint Thomas in Tennessee is one of the largest healthcare providers in the state. Offering rewarding careers across 12 hospital campuses and a comprehensive network of affiliated joint ventures, medical practices, clinics, and rehabilitation facilities, you will find an environment that allows you to thrive and create a career path you love. As we continue to grow, we need compassionate caregivers, like you, to join us and influence care across our communities.

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Equal Employment Opportunity Employer

Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.

For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

Pay Non-Discrimination Notice

Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.

E-Verify Statement

This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.

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