Audit & Appeal Nurse
Location: Sarasota Florida
Description: Venice Regional Medical Center is looking of Audit & Appeal Nurse right now, this career will be placed in Florida. Detailed specification about this career opportunity kindly see the descriptions. Position Responsibility:
Coordinate commercial/managed care audit requests, as assigned
Validate and compile audit findings
Exit/finalize all completed audits, as requested
Draft (in conjunction with a physician reviewer when indicated) medical necessity appeals, as assigned
Follow-up on all appeals for determinations and additional actions/resolution
Reviews, investigates and appeals all clinical level denials such as not medically necessary surgeries, inpatient stays or levels of care
Audit Medical Records to retrieve clinical information requested from payors, governmental agencies, etc.
Assist and conduct audits as requested pertaining to the review of clinical documentation
Communicates with all parties in a professional manner to alert specific problem issues
Ensure confidentiality of all patient accounts by following HIPAA guidelines
Performs other duties as assigned
Requirements
Required Education:
At least a 2 year degree in nursing required, Bachelor’s or above preferred. Current Nursing license (RN/LPN)
Desired Experienc! e:
Three years of experience in Case Management desire! d
Three years of experience nursing in a hospital setting required
One year experience with medical necessity appears preferred
Two years acute care hospital inpatient coding and or charge auditing experience is preferred
Desired Traits:
Willingness to accept responsibility
Ability to direct ancillary staff and organize work assignments
Proven leadership skills
Ability to perform under stressful conditions
Working knowledge of the Revenue Cycle
Working knowledge of medical terminology and/or insurance claim filing experience
Detail oriented, analytical and able to problem solve
Excellent oral and written skills
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Venice Regional Medical Center.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Thu, 07 Nov 2013 14:01:55 GMT