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Prebill Denials RN

Company: Capitol View Bldg 1600
Location: Nashville
Posted on: December 10, 2018

Job Description:

Prebill Denials Nurse


Parallon
believes that organizations that continuously learn and improve will thrive. That's
why after more than a decade Parallon remains dedicated to helping hospitals
and hospital systems operate knowledgeably, intelligently, effectively and
efficiently in the rapidly evolving healthcare marketplace, today and in the
future. As one of the healthcare industry's leading providers of business and
operational services, Parallon is uniquely equipped to provide a broad spectrum
of customized revenue cycle services.


Job Summary - The Prebill Denials Nurse will
review post discharge, prebill accounts that do not have an authorization on
file, ALOS versus days authorized variances, and/or other account discrepancies
identified that will result in the account being denied by the payor that
require clinical expertise. Communicates with third party payors to resolve
discrepancies prior to billing. Accurately and concisely documents all
communications and action taken on the account in accordance with policies and
procedures. Escalate medical review request and/or denial activities to
management as needed.



Duties:

  • Work post discharge, prebill accounts
    efficiently and effectively on a daily basis to resolve accounts with no auth
    numbers, ALOS vs. authorized days or other discrepancies
  • Evaluates clinical documentation on multiple
    patient accounts and escalates issues through the established channels
  • Perform accurate and timely documentation of
    all review activities based on policy and procedure
  • Demonstrates a working knowledge of managed
    care agreements based on available resources which may include and not be
    limited to payer UM Manual, policy and procedure, facility contract
    information. Escalates variations timely.
  • Work assigned accounts in eRequest to resolve
    outstanding issues
  • Report insurance denial trends identified
    during daily operational assignments
  • Contact facilities, physicians' offices and/or
    insurance companies to resolve denials/appeals if needed
  • Demonstrates knowledge of regulatory
    requirements, Ethics and Compliance policies, and quality initiatives; monitors
    self-compliance and implements process changes to ensure compliance to such
    regulations and quality initiatives.
  • Assess CPT code(s) for outpatient accounts that
    require authorization when accounts have not been coded
  • Seeks assistance from immediate supervisor when
    in situations which are unclear or ambiguous
  • Communicates effectively and professionally
    with physicians, hospital staff, and outside agencies
  • Participate in education and training as needed
  • Establish and maintain relationships with all
    customers


























    EDUCATION

    • Registered Nursing degree and current licensure



      EXPERIENCE

      • Healthcare experience in an acute care
        hospital. Utilization Review, appeals, denials, managed care contracting,
        experienced preferred



        CERTIFICATE/LICENSE -

        • RN with current state licensure


          Apply Now!

          Keywords: Capitol View Bldg 1600, Nashville , Prebill Denials RN, Healthcare , Nashville, Tennessee

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