• Coordinator-RAC TPE

    Location US-TN-MEMPHIS
    Posted Date 1 month ago(8/13/2019 10:53 AM)
    Position Code
    12472
    Day Shift
    Yes
    Night Shift
    No
    Rotating Shift
    No
    Evenings
    Yes
    Status
    Regular Full-Time
    Department
    HS Revenue Audit
  • Overview and Responsibilities

     

     

    Medicare / Medicaid Appeals Registered Nurse to reviews and evaluates medical documentation to support billing compliance and external regulatory requirements. Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors.  Is responsible for the evaluation coordination, and appeal of third party determinations on all levels of the governmental appeal process. Educating department staff to issues related to the reimbursement process, as well as other concerns that result from monitoring activities. Incumbent is also responsible for resolving issues as they occur. Performs other duties as assigned.   #CB

     

     

    auditor

    case management

    clinical documentation

    analyst

     

    Qualifications

     

    MINIMUM QUALIFICATIONS

    KNOWLEDGE/

    EDUCATION

    Experience Minimum Required:

    1.     5 years of healthcare care experience and 3 years in Medicare billing environment.

    2.     Previous audit experience, knowledge of InterQual and Medicare Billing practices.

    Experience Preferred/Desired: None

    Education Minimum Required:

    1.     BSN or RN with BS/BA in Business Administration or Management

    2.     Strong knowledge of state and federal healthcare laws and regulations.

    3.     Understanding of CMS coverage and payment methodologies

    Special Skills Minimum Required:

    1.     Excellent oral and written communication skills.

    2.      Advanced computer proficiency, excellent organizational and time management skills.

    Licensure Minimum:

    1.     RN

     

     

    EXPERIENCE

    Successful demonstration and detailed understanding of Hospital Revenue Cycle, CPT codes, HCPC codes, modifiers, and the Medicare/Medicaid Appeals Process.

     

     

    LICENSURE, REGISTRATION, CERTIFICATIONS

    Familiarity of billing regulations including federal and guidelines.

     

    Must have excellent communication skills and proven ability to present. 

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed