Audit & Appeals Nurse-LCMC Job at LCMC Health
POSITION SUMMARY:
Reporting to the Audit and Appeals Supervisor, the Audit and Appeals Nurse plays an important role in a high-profile group tasked with audits and appeals for all government and commercial payers due to Audit request and denials. The focus is to improve revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to the final bill generation. Due to its service focus and project management emphasis, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, and the ability to meet deadlines while influencing, but not directly managing the work of others.
JOB DESCRIPTION DISCLAIMER:
The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
JOB SPECIFICATIONS:
Minimum Required:
Bachelor’s Degree
Graduate of an accredited nursing school in Nursing
Minimum Required:
At least 5 years minimum experience in clinical setting with an Associate’s degree or Practical Nursing Program completion
or 3 years of experience in a clinical setting with a Bachelor’s Degree in Nursing.
Minimum Required:
Knowledge of accurate sources for updating all applicable code sets (CPT/HCPCS, ICD-10, etc.) inclusive of associated edits such as NCCI.
Knowledge as it relates to, but not limited to, electronic health record, health information systems and healthcare applications.
Understanding of multiple reimbursement systems including IPPS, OPPS, and Managed Care.
Demonstrated knowledge of computer technology and preferred knowledge of MS Office including Word, Excel, and PowerPoint.
Excellent oral, written and interpersonal communication skills.
Well-developed research skills and detail oriented with the ability to organize and set priorities to ensure objective are met in a timely manner.
Ability to interpret and implement regulatory standards.
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