Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory requirements.Responsibilities
Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors.
Educates department staff to issues related to the reimbursement process, as well as other concerns that result from monitoring activities.
Responsible for resolving issues as they occur.
Other duties as assigned.
Requirements, Preferences and Experience EducationPreferred: BSN or RN with BS/BA in Business Administration or ManagementMinimum: Diploma RN or RN AD ExperiencePreferred: PREFERRED 5 years of healthcare care experience and 3 years in Medicare billing environment. Previous audit experience, knowledge of InterQual and Medicare Billing practices. Minimum: Required 2 years of healthcare care experience as RNLicensure, Registration, CertificationMinimum: RNSpecial SkillsMinimum: Strong knowledge of state and federal healthcare laws and regulations. Understanding of CMS coverage and payment methodologies TrainingMinimum: Successful demonstration and detailed understanding of Hospital Revenue Cycle, CPT codes, HCPC codes, modifiers, and the Medicare/Medicaid Appeals Process. Familiarity of billing regulations including federal and guidelines. Must have excellent communication skills and proven ability to present. About Baptist Memorial Health Care At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.At Baptist, We Offer:
Competitive salaries
Paid vacation/time off
Continuing education opportunities
Generous retirement plan
Health insurance, including dental and vision
Sick leave
Service awards
Free parking
Short-term disability
Life insurance
Health care and dependent care spending accounts
Education assistance/continuing education
Employee referral program
Job Summary: Position: 12472 - Coordinator-RAC TPEFacility: BMHCC Corporate OfficeDepartment: HS Revenue Audit CorporateCategory: Finance and AccountingType: Non ClinicalWork Type: Full TimeWork Schedule: DaysLocation: US:TN:MemphisLocated in the Memphis metro area REQNUMBER: 20621