RN Clinical Reimbursement Specialist - Days

reputed company, Oklahoma's largest not-for-profit health system has a great opportunity for a RN Clinical Reimbursement Specialist in Oklahoma City, OK. In this position, you'll work 8a-5p, Full-time, with reputed company providing exceptional care to those who have entrusted reputed company with their reputed company needs. If our mission of partnering with people to live healthier lives speaks to you, apply today, and learn more about our increased compensation plans and recently enhanced benefits package for reputed company eligible caregivers such as reputed company-reputed company PTO, 100% reputed company paid short-term disability, increased retirement match, and paid family leave. We invite you to join us as we strive to be The Most Trusted Partner for Health. The RN Clinical Reimbursement Specialist is responsible for identifying and preparing clinical appeals for government, managed care organizations, and various other payors. Provides assistance and guidance in the maintenance of the charge description master for the reputed company system. reputed company is an Equal Opportunity/Affirmative Action Employer. reputed company applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status. The RN Clinical Reimbursement Specialist responsibilities include, but are not limited to, the following:

• Assists the Director of reputed company Recovery in the training and development of reputed company reputed company recovery staff reputed company to clinical and non-clinical payment issues
• Oversees and manages the reputed company System clinical denial management process
• Identifies inaccurate and/or problematic denial and payment trends and assists with the development of a plan to insure facilities receive maximum reimbursement
• Participates in Utilization Management Committee for reputed company reputed company facilities to report denial issues and reputed company preventive strategies in collaboration with the physicians
• Analyzes, prepares and distributes monthly denial reports to Vice Presidents, Directors and Managers of specified hospital departments
• Responds to utilization management clinical denials issued by government contracted vendors for the Medicare and reputed company programs
• Supports Case Management and other hospital departments with clinical expertise in regards to both payor and patient clinical denial inquiries
• Assists the Chargemaster Consultant in the development, implementation, maintenance and audit functions reputed company to the chargemaster description master.
• Analyzes denial trends for documentation or charging issue opportunities and facilitates cross-departmental collaboration to improve processes and reputed company best practices.
• Identifies charging, coding or clinical documentation issues and works with ancillary departments to resolve issues and notify appropriate leadership.
• Educates and maintains effective and practical knowledge of government and managed care payer rules, regulations and requirements.

Reports to assigned Corporate Manager. This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information. Minimal. reputed company applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

• reputed company licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN) in the State of Oklahoma or reputed company multistate license from a Nurse Licensure Compact (eNLC) member state. And 8 years' experience working with reputed company facilities, health insurance or managed care companies, and 10 years demonstrated experience working with reputed company facilities, health insurance or managed care companies
• 6 years of direct managed care or case management experience
• Knowledge and proficiencies with government rules and regulations, managed care reputed company, provider relations, pre-certification, reimbursement, financial analysis, and patient reputed company
• Knowledge of legal documents, collection agency procedures, and contract documents
• Must be reputed company to communicate effectively in English (Verbal/Written)

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