Registered Nurse Case Manager - Government Audits, Denials, & Appeals
Location: Stamford Connecticut
Description: Stamford Hospital is at present looking to employ Registered Nurse Case Manager - Government Audits, Denials, & Appeals right now, this vacancy will be placed in Connecticut. Detailed specification about this vacancy opportunity kindly read the description below. The Government Audits, Denials & Appeal RN Case Manager is responsible for the revie! w of all Centers for Medicare & Medicaid (CMS) Contractor inpatient medical necessity audits, denial notifications and third party DRG determinations and coordination of the appeal process. This position is also responsible for auditing the denials to identify organizational risk and training opportunities. Performs research and analysis on trending to reduce errors. Documents, tracks and communicates findings to Management and Senior Leadership.
Required Skills
Required Experience
RN, BSN and current Connecticut RN License required (or applied for).
Additional Skills - Must have a solid, acute care case management and/or knowledge of updated CMS Acute Care inpatient criteria inpatient coding skills to include thorough knowledge of ICD-9-CM/ICD-10 and CPT coding guidelines (inpatient and outpatient), DRG systems and documentation requirements, coding compliance guidelines, coding clinic references and other related CMS regulations. Knowle! dge of care delivery documentation systems and related medical! record documents. Knowledge of elements of disease processes and related procedures. Thorough, up-to-date clinical skills, current working knowledge of pathology, pharmacology, surgical procedures, etc. Excellent written communication skills a must. Experience working directly with physicians. Knowledge of Revenue Cycle and financial billing codes/practices. Minimum of 5 years inpatient case management and or clinical documentation experience in a large acute care facility.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Stamford Hospital.
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This vacancy starts available on: Mon, 18 Nov 2013 09:06:07 GMT
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