- Working knowledge of all facets of insurance claim filing, requirements, and regulations. Review and perform all retrospective inpatient authorizations of days of stays. (16%)
- Reviews, investigates and appeals all clinical level denials such as not medically necessary surgeries, inpatient stays or levels of care. Communicates results of audit/review results timely. (16%)
- Audit Medical Records to retrieve clinical information requested from payers, governmental agencies, etc. Draft (in conjunction with a physician reviewer when indicated) appeal letters. Review and process all correspondence including approvals and denials/adjustments, demand letters and results from various levels of appeals. (16%)
- Manages the operational aspect of other types of audits when requested. Maintain knowledge of SSC policies and procedures as it relates to department job functions. Ensures the appeal process flow for clinical staff and physicians meet appeal deadlines. Working with team to monitor, track, trend and coordinate denial resolution with facilities. (16%)
- Communicates with all parties in a professional manner to alert specific problem issues. Ensure confidentiality of all patient accounts by following HIPAA guidelines. Adheres to compliance of CMS and other payer guidelines. Attend in-services, education sessions and department meetings as scheduled. (16%)
- Displays an overall teamwork design, relationship building and coordination of activity. Practices the Standards of Service for the Shared Services Center. (10%)
- Performs other duties as assigned by leadership. (10%)
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Clinical Coordinator-Nursing
1 week ago
Baptist Health Fort Smith, United StatesShift: VariesWorking Hours: varies Summary:A registered nurse at Baptist Health is accountable for utilizing the nursing process and the training provided by Baptist Health to provide safe, therapeutic, and compassionate patient care. The nurse is expected to demonstrate clinical ...
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Clinical Coordinator-Nursing
1 week ago
Baptist Health Fort Smith, United StatesShift: Varies · Working Hours: varies · Summary: · A registered nurse at Baptist Health is accountable for utilizing the nursing process and the training provided by Baptist Health to provide safe, therapeutic, and compassionate patient care. The nurse is expected to demonstra ...
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Patient Care Manager RN
3 weeks ago
Access Home Health Fort Smith, United States Full timeWe are hiring for an RN Patient Care Manager. · At Access Home Health, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serv ...
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Weekend Regular Visit Sat-Sun RN Hospice
2 weeks ago
Heart of Hospice, LLC Fort Smith, United States Full timeWe are hiring for a Registered Nurse Case Manager in Hospice. · At Heart of Hospice, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the commun ...
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Resident Assessment Nurse
1 day ago
NHS Management Services Fort Smith, United StatesAre you looking for something a little different in a healthcare career? A position that only requires patient assessment as the only direct care and Monday through Friday schedule? If so, then you might be the perfect fit for a Resident Assessment Nurse (RN) position within the ...
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Clinic LPN or MA
1 week ago
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RN Hospice
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RN Hospice
1 week ago
Heart of Hospice, LLC Poteau, United States Full timeWe are hiring for a Registered Nurse Case Manager in Hospice. · At Heart of Hospice Hospice, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and th ...
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Clinic LPN or MA
21 hours ago
Mercy Fort Smith, United States Clinics and Virtual CareM-F, 40 hours per week · Mercy Clinic Rogers Ave · CardiologyTuition Reimbursement up to $2,000 for continuing education · Health/Dental/Vision available after day one · Annual contribution of $100 per month to eligible co-workers enrolled in the Dependent Care FSA · Paid pare ...
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Primary Care
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Clinic LPN or MA-OBGYN: Fort Smith
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Medical Assistant
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Primary Care LPN or MA
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Primary Care Assistant
1 week ago
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Clinical Supervisor
1 week ago
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Mental Health Counselor
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Social Worker II-IPCM, PT
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Child/Adolescent Inpatient Therapist
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Child/Adolescent Inpatient Therapist
2 days ago
Valley Behavioral Health Fort Smith, Arkansas, United States PermanentOverview: · We are proud to provide CEU reimbursement, furthering education certification reimbursement, and paid supervision · Responsibilities: · Experience working with similar population for one to two years in therapy is preferred but not required. · Master's degree in Psych ...
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Adult Inpatient Therapist
3 weeks ago
Acadia Healthcare Barling, United StatesWe are proud to provide CEU reimbursement, furthering education certification reimbursement, and paid supervision · Experience working with similar population for one to two years in therapy is preferred but not required. · Master's degree in Psychology, Social Work, Counseling o ...
Remote Denial Coordinator-Clinical- RN - Fort Smith, United States - Community Health System
Description
Job DescriptionThis position requires a valid RN (Registered Nurse) license. This is a remote position with no direct patient care.
The first 2 weeks of orientation is 8:00am-4:30pm CST.
After orientation, the training is 8:00am-4:30pm CST for the first week.
Then, the second week of training is typically 7:00am-3:30pm CST for at least 6 weeks.
The working hours are 7:00am-3:30pm CST.
Essential Duties and Responsibilities:
(List in order of importance or percentage of time spent on the particular responsibility. High to Low)
Qualifications:
Required Education:
Bachelor of Science in Nursing (BSN), Two-year Associate Degree in Nursing (ADN) or Equivalent
Required Experience: 2+ years of experience as a hospital-based nurse including clinical decision making knowledge
Preferred Experience: 3+ years of experience as a Case or Resource Manager including 1 year experience with medical necessity appeals at all levels
Required License/Registration/Certification:
RN (must possess and maintain a current nursing license)
Reasoning Ability:
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Computer Skills:
To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.
Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:
The Employee is required to read, review, prepare and analyze written data and figures, using a pc or similar and should possess visual acuity.
The Employee is not substantially exposed to adverse environmental conditions and therefore job functions are typically performed under conditions such as those found in general office or administrative work.
