Healthcare Coordination Specialist

7 days ago


Houston, Texas, United States Nexus Health Systems Full time
Job Summary
Care Coordinators play a vital role in supporting the coordination of clinical objectives for patient referrals towards exceptional performance at Nexus Health Systems. The successful candidate will have financial and clinical accountability over referral protocols, working collaboratively with clinical and non-clinical departments to meet organizational objectives.

Key Responsibilities:
•Maintain utmost confidentiality at all times
•Adhere to health system policies and procedures
•Responsible for promoting adherence to applicable State/Federal laws and regulations
•Provides support to team members and utilizes critical thinking to minimize insurance denials and appeals
•Evaluates incoming referrals and identifies appropriate programming based on clinical presentation
•Develops clinical summaries to support recommended clinical programming
•Maintains referral correspondence within a centralized database
•Responsible for timely research and evaluation of Medicaid, Medicare regulations, as well as Commercial Payer regulations
•Participate in denials and appeals as it relates to clinical justification or documentation

Requirements:
•Associate's degree in nursing (RN) or Bachelor of Science in Nursing (BSN)
•Two (2) years of healthcare experience in a clinical review setting
•Certified Revenue Cycle Representative (CRCR) preferred

Estimated Salary:$65,000 - $85,000 per year

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