What are the responsibilities and job description for the RN - Revenue Cycle Clinical Reviewer position at Avita Health System?
In collaboration with the Revenue Cycle departments and IT, is responsible for the identification, mitigation, and prevention of clinical denials as well as chart to charge auditing. Assists in obtaining prior authorizations where clinical information is required or additional procedures may need authorized. Reviews clinical denials to determine next steps and conducts appeals as appropriate, as well as works to prevent future denials by communicating with clinical and revenue cycle leadership about denial root causes and by developing and implementing staff education and process changes.
Shift information: Monday - Friday - 8:00 am - 4:30 pm
Requirements:JOB REQUIREMENTS
- Registered nurse with at least 5 years of hospital patient care experience
- Strong computer skills, including knowledge of billing software functionality and PC-based productivity tools (e.g. spreadsheets, word processing, email).
- Ability to research, analyze and problem solve.
- Excellent organization and time management skills, and the ability to effectively establish priorities required.
- Must project a mature, compassionate, customer-focused attitude and professional demeanor.
PREFERRED
- Knowledge and understanding of payer reimbursement requirements
- Certified hospital coder
- Case management and/or clinical appeal experience
