What are the responsibilities and job description for the RN Coordinator, Audits and Appeals position at Grand View Health?
Responsibilities:
The RN Audit and Appeals Coordinator will also support appeal and denial activity for the Case Management department and supports the Director of Case Management and Physician Advisor in managing this departmental function effectively. They will work with the Director of Case Management and Physician Advisor on:
These duties will require the understanding of many complex and varying guidelines, systems, regulations and tools. The RN Audit and Appeals Coordinator will use critical thinking skills to manage an ever-evolving process that includes financial, clinical and legal components. The RN Audit and Appeals Coordinator will proactively work with GVH staff and physicians to put processes in place and to correct identified deficiencies that are impacted by retrospective denials.
Schedule: Rotational remote work eligible, Monday - Friday, 8:00 am - 4:30 pm.
Qualifications:
Licenses and Certifications:
Registered Nurse in PA – Licensed, upon hire, required
RHIA/RHIT certification, upon hire, preferred
Benefits:
We offer a competitive salary and comprehensive benefits to part-time and full-time employees including:
Under the general direction of the Manager of Health Information Management, the The RN Audit and Appeals Coordinator coordinates Recovery Audit Contracting activities and other post discharge denials to ensure that deadlines are adhered to. This role involves:
- Reviewing medical records,
- Analyzing clinical information and preparing written appeals.
- Responsible for health system compliance with all federal, state, and regulatory agencies to manage payer post discharge audits and appeals.
- Assumes the role of system administrator for the Audit and Appeals software product.
- If allowable, the role will assist with Joint Commission audits as requested, as well as Core Measure abstraction and PHC4 data set management and submission as necessary and/or requested.
The RN Audit and Appeals Coordinator will also support appeal and denial activity for the Case Management department and supports the Director of Case Management and Physician Advisor in managing this departmental function effectively. They will work with the Director of Case Management and Physician Advisor on:
- Strategy development and effectively implement protocols for the appeals process based on third party payor trends and contracts.
- Support the Utilization Review Team with the appeals and denials process, and
- Keep the Director of Case Management abreast by providing reports on trends.
These duties will require the understanding of many complex and varying guidelines, systems, regulations and tools. The RN Audit and Appeals Coordinator will use critical thinking skills to manage an ever-evolving process that includes financial, clinical and legal components. The RN Audit and Appeals Coordinator will proactively work with GVH staff and physicians to put processes in place and to correct identified deficiencies that are impacted by retrospective denials.
Schedule: Rotational remote work eligible, Monday - Friday, 8:00 am - 4:30 pm.
Qualifications:
Education and Experience:
Nursing Diploma or Associates degree minimum requirement, and over 1 year to 3 years Healthcare Audit & Appeals experience required.
Nursing Diploma or Associates degree minimum requirement, and over 1 year to 3 years Healthcare Audit & Appeals experience required.
1 year or more experience preferred in hospital or insurance organizations, acute care utilization management, IT platforms that support utilization management and HIM denial functions (CarePort, Craneware Meditech), and Managed care systems & contracts.
Licenses and Certifications:
Registered Nurse in PA – Licensed, upon hire, required
RHIA/RHIT certification, upon hire, preferred
Benefits:
We offer a competitive salary and comprehensive benefits to part-time and full-time employees including:
- Medical, dental, & vision insurance available 1st of the month after start date
- Wellness and gym discounts & free cardiac rehab gym
- 403B
- On-site discounted childcare center
- Paid time off
- Sick time for full-time employees
- Tuition assistance
- Free life insurance for full-time employees
- Long term disability for full-time employees
- Short-term disability
- Employee referral bonus
- Identity theft insurance
- Pet Insurance
- Flexible spending accounts
- Employee discount program
- Employee Assistance Program
- Free parking
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