Denial Prevention Nurse Consultant

Revecore•Remote,

13d•Remote

About The Position

Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We're powered by people, driven by technology, and dedicated to our clients and employees. If you're looking for a collaborative and diverse culture with a great work/life balance, look no further.

Requirements

College degree or diploma from school of nursing -- must be RN
Clinical nursing experience working in hospital environment, preferably in ER, Critical Care or diagnostic services
Minimum 5 years of related experience and/or training in utilization review or patient accounting
Are highly proficient with Interqual and MCG guidelines and demonstrate appropriate application to claim appeal argument
Understand patient accounting documents -- UB04, EOB
Have a working knowledge of Microsoft Office (Word, Excel, Outlook)
Possess technical proficiency to work on multiple computer screens and software applications simultaneously
Are able to read and interpret an extensive variety of documents such as medical records, patient care systems, instructions, policies and procedures in written (in English) and diagram form
Can maintain strong performance in a fast-paced environment with productivity metrics
Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies
Have experience with healthcare billing software and databases (EPIC, Cerner, Meditech)
A private, distraction-free environment to work from in your home
On-Camera Presence: Being on camera is an essential part of our culture--it helps build trust, support collaboration, and strengthen team connections
A secure internet connection
Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads
Must reside in the United States within one of the states listed below: Alabama, Arkansas, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia and Wisconsin

Nice To Haves

Extensive 90-day training with ongoing support from teammates following training
Access to a robust knowledgebase for continued reference in your role
Visibility to your individual performance metrics enables you to set goals
Computers and necessary work equipment are provided
Involved management who leans in to support your productivity metrics

Responsibilities

Build strong, lasting relationships with clients, payors and Revecore personnel
Analyze medical records or other medical documentation to validate services, tests, supplies and drugs performed for accuracy related to billing for services rendered
Identify and interpret medical, radiological, laboratory or other tests and procedures as well as pharmaceutical drugs
Review and understand managed care contracts, hospital billing statements/bills and insurance denials
Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims
Perform research regarding denials and effectively communicate information to associates, colleagues, managers and clients
Contact insurance company to obtain missing information, explain and resolve underpayments and/or denials and arrange for payment or adjustment processing on behalf of client
Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
Perform denial trending for clients, identify fail points within the revenue cycle and on the payer side, and provide best practice recommendations to clients and Revecore managers
Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnel
Maintain confidentiality of information in compliance with company policy and HIPAA
Attend client, department and company meetings
Lead client meetings and perform consulting services to client's as it relates to medical necessity of services performed and proper vetting of payers criteria