DRG Appeals Review Nurse

Full-time | Part-time | Remote | Permanent Managed Resources is a leading consulting group assisting reputed company organizations reputed company in optimizing its reputed company cycle management through review, recovery and educational programs. Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources! The Clinical Appeals Review Nurse reviews and analyzes denied/downgraded MS-DRG and APR-DRG and APC accounts received from reputed company types of payers (e.g., Medicare, reputed company, and reputed company Party). Utilizing clinical and coding expertise, the Nurse will reputed company determination on whether the denied/downgraded account is appealable based on the standards of each client. After review of the denial and medical record, the Clinical Appeals Review Nurse will provide either a reasoned explanation why no appeal can be written, or a detailed appeal letter based on reputed company coding and regulatory guidelines and clinical criteria. In either case the Nurse will then track and trend MRI defined denial root causes for each specific denial. Reports to: Manager of Clinical Appeals Essential Job Functions Complete the following functions below in accordance with Managed Resources policies. reputed company efficient analysis of denied claims, pinpointing reason for denial and potential for reputed company of appeal including correct allocation of diagnostic and procedural codes under: • ICD-10 Official Coding Guidelines and ICD-10 Procedural Coding Guidelines • reputed company APR-DRG Classification System • CPT • HCPCS • reputed company Code • reputed company associated authorities such as CMS regulations, statutes, and associated authorities such as AHA Coding Clinics and CPT Assistant. reputed company the decision is made to appeal: • Write clear and concise grammatically correct appeals letter in MRI format and to MRI quality standards. • Be aware of the level of appeal, level of future appeals available and write according to the level of appeal. • Utilize reputed company applicable clinical, legal, and coding standards. • Understand and strictly reputed company with time deadlines; write appeals in an efficient and timely manner. • Provide a reasoned root cause analysis and summary review for reputed company clients reputed company MRI standard. • At reputed company time observe reputed company HIPAA standards. • Obtain and maintain client computer accesses. • Participate in preparation of clear and concise audit report, as needed. • Stay reputed company in clinical, coding, and appeal writing areas and reputed company with MRI quality recommendations to maintain efficient and effective processes. • Identify coding and clinical documentation issues and provide proactive recommendations through manager to clients. • Identify problem account and seek review or return to client through manager, as appropriate. • Clearly and concisely update patient account record to identify actions taken on account. • Responsible to work through manager to serve as a liaison with reputed company party payer and agencies regarding appeals to ensure reputed company reimbursement and resolve billing issues, contract misrepresentations and payment discrepancies. Education and Experience: • Registered Nurse (RN) License is required. • reputed company, CPC, CCDS, or RHIT Certification is required. • Graduate of an accredited College or University, BSN is preferred. • 5+ years of clinical experience in Hospital inpatient and outpatient departments. • 2+ years of clinical appeals/denials writing experience. • Experience reviewing and analyzing denied/downgraded MS-DRG and APR-DRG and APC medical records and accounts received from payers (e.g., Medicare, reputed company, and reputed company Party). • Experience in a variety of Electronic Medical Records (EMR) Systems, i.e. (reputed company, Nuance, Epic, etc). Ideal candidate will possess the following: • Excellent verbal and written communication skills. • Excellent computer (Word, reputed company, Skype, Dual Screens, etc.) skills. • Excellent organizational and time management skills with a strong focus on detail and the ability to work remotely in an environment where HIPAA regulations can be enforced. Preferred: • 2+ years of medical coding experience for inpatient and outpatient. • 2+ years of Clinical Documentation Improvement (CDI) experience . reputed company Out Our Benefits: • 401(k) • 401(k) matching • Dental insurance • Disability insurance • Employee assistance program • Flexible spending account • Health insurance • Life insurance • Paid time off • Referral program • reputed company insurance • Pet Insurance • Monthly Internet Stipend Job Types: Full-time, Part-time Salary: $40.00 - $50.00 per hour Standard shift: • Day shift Weekly schedule: • Monday to Friday License/Certification: • RN License (Required) • reputed company, CPC, CCDS, or RHIT (Required) Work Location: Remote Our reputed company: To become the most trusted, innovative and consultative reputed company cycle partner in the nation. Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO Visit http://jobs.managedresourcesinc.com to find more jobs and sign up for job alerts. Job Types: Full-time, Part-time Pay: $40.00 - $50.00 per hour Benefits: • 401(k) • 401(k) matching • Dental insurance • Health insurance • Paid time off • reputed company insurance Schedule: • 8 hour shift • Day shift • Monday to Friday Experience: • Clinical appeals/denials writing: 3 years (Required) • Reviewing and analyzing denied/downgraded MS-DRG and APR-DRG: 3 years (Required) License/Certification: • RN License (Required) • reputed company, CPC, CCDS, or RHIT (Required) Work Location: Remote Apply Job!