Prebill Denials Analyst- LPN occupation at PAS - Nashville in Nashville

PAS - Nashville is at the momment seeking for Prebill Denials Analyst- LPN on Thu, 08 Aug 2013 07:25:18 GMT. 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...

Prebill Denials Analyst- LPN

Location: Nashville Tennessee

Description: PAS - Nashville is at the momment seeking for Prebill Denials Analyst- LPN right now, this occupation will be placed in Tennessee. More complete informations about this occupation opportunity kindly read the description below. 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 oth! er 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 (included but not limited to):

• 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 chain

of command

• Perform accurate and timely documentation of all review activities based on policy and procedure
• Demonstrates a worki! ng knowledge of managed care agreements based on available res! ources 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.

• Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous
• Communicates effectively and professionally with physicians, hospital staff, and outside agencies
• Adhere to all policies and procedures, including, ! attendance, phone and internet usage, break utilization, etc.
• Participate in education and training as needed
• Establish and maintain relationships with all customers
• Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous
• Adheres to established policy and procedure and standards of care; escalates issues through the established Chain

of Command timely

• Demonstrates commitment to teamwork and cooperation
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned

Qualifications

• Customer Orientation â€" establishes and maintains long term customer relationships, building trust and respect by

consistently meeting and exceeding expectations

• Communication - communicates professionally, clearly and concisely
• Interpersonal skills â€" ab! ility to establish and maintain collaborative and effective working rel! ationships
• PC Skills â€" demonstrates advanced proficiency in Microsoft Office applications and others data mining software
• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and

systems

• Basic skills â€" demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes and

have ability to work quickly and accurately in a fast-paced environment while managing multiple demands

• Clinical skills â€" ability to read/ interpret medical record documentation and present the clinical data obtained in an

organized, concise dialogue to the payor in order to obtain auth and/or resolve other issues.

EDUCATION

• Associate’s Degree or higher preferred

EXPERIENCE

• Utilization Review, appeals, denials, managed care contracting, experienced preferred

CERTIFIC! ATE/LICENSE â€"LPN/LVN with current state licensure
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to PAS - Nashville.

If you interested on this occupation just click on the Apply button, you will be redirected to the official website

This occupation starts available on: Thu, 08 Aug 2013 07:25:18 GMT

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