Revenue Cycle Medical Billing Resource Utilization Clinical Auditor

Air Evac Lifeteam•West Plains, MO

1d•Remote

About The Position

This role involves reviewing and auditing medical necessity justification for air and ground ambulance transports, and submitting medical necessity appeals for commercial payors. The auditor will utilize clinical experience, established clinical standards, and protocols to validate air medical necessity and appeal payment denials.

Requirements

Licensed RN with minimum of five years in Emergency department (ED), Intensive Care Unit (ICU), flight or ambulance experience or job experience equivalent
Proficient in Word, Excel, Office 365
Current RN licensure, is required
Excellent written communication skills
Ability to define and identify problems, collect data, establish facts, and draw valid conclusions
Ability to respond to inquiries or complaints from customers in a positive and productive manner
Ability to calculate numbers, correct entries, and post to records
Ability to gather data from hospital and EMS charts, phone calls, emails, colleagues, and internet research, then compile information and prepare reports and letters
Ability to use independent judgment and to manage and impart confidential information
Ability to research local EMS protocols, hospital referrals, and standards of care
Ability to review clinical charts and development of constructive feedback

Nice To Haves

Some supervisory/leadership experience preferred (i.e.: team leader, FTO, charge nurse, preceptor, educator, etc.)
Bachelor’s degree in nursing or equivalent, is preferred
CFRN, CEN or CCRN, is preferred

Responsibilities

Conduct audits of the medical necessity appeals for all payor sources in the role of advocate for the patient and GMR.
Ensure appeal timelines are met by moving the assigned book of business through the appeals process and updates appeals database.
Work with fixed deadlines and demonstrates willingness to meet and exceed performance metrics.
Work with the Appeal team to determine the best approach to each clinical denial in order to maximize claim reimbursement and minimize the financial risk to patients and GMR.
Maintain strict confidentiality of all protected health information and cooperates fully with all information security guidelines related to the scope of work.