Medical Billing Revenue Cycle Resource Utilization Clinician

$63,000 - $63,000/Yr

GLOBAL MEDICAL RESPONSE - West Plains, MO

Full-time - Mid Level

West Plains, MO

Ambulatory Health Care Services

About the position

The Medical Billing - Revenue Cycle - Resource Utilization Clinician provides medical necessity justification for air transport evaluation and evaluation/submission of all medical necessity appeals for Medicare, Medicaid and Workers' Compensation payors. They utilize clinical experience and establish clinical standards and protocols to validate air medical necessity and appeal payment denials.

Responsibilities

• Conducts the medical necessity appeals for all payor sources as the advocate for the patient and GMR
• Receives the appeal request from the Appeal Prepper and inputs the information into database
• Ensures appeal timelines are met by moving the assigned book of business through the appeals process and updates appeals database
• Works with fixed deadlines and demonstrates willingness to meet and exceed performance metrics
• Collaborates with the Appeal team to determine the best approach to each clinical denial to maximize claim reimbursement and minimize the financial risk to patients and GMR
• Maintains strict confidentiality of all protected health information and cooperates fully with all information security guidelines related to the scope of work

Requirements

• Minimum of five years in Emergency department (ED), Intensive Care Unit (ICU), flight or ambulance experience or job experience equivalent
• Experience with researching EMS protocols, hospital referrals, clinical charts, and standards of care
• Proficient in Word, Excel, Office 365
• Current RN licensure for nurses is required
• Bachelor's degree in nursing or equivalent is preferred for nurses
• Current NREMT-P for paramedics is required
• Associate's degree in EMS/related field or two years of college is preferred for paramedics

Nice-to-haves

• Supervisory/leadership experience preferred (i.e.: team leader, FTO, charge nurse, preceptor, educator, etc.)
• FP-C, CCP-C or CP-C is preferred

Benefits

• Medical insurance
• Vision insurance
• Dental insurance
• 401k
• Disability insurance
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Employee Assistance Program (EAP)
• Vacation and paid time off