What are the responsibilities and job description for the Nurse Auditor Reviewer position at Phelps Health?
Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri.
No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.
General Summary
No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.
General Summary
- This position supports the Denial, Prevention, and Recovery Department (DPR) by providing Clinical Data Analyst and Review services. The Nurse Auditor performs appeal writing, reviews, and other tasks that may be assigned by the Denial and Prevention Director. Also serves as a contact person/liaison between auditors/external resources. Evaluates trends in denials, high risk areas and provides education.
- Retrieves patient medical records to compile all requested documentation in the format stipulated and within the timeframe requested by CMS.
- Tracks audit requests/appeals/due dates/correspondence and communicates with payer/auditor.
- Compiles and presents reports on behalf of the Denial & Prevention Department.
- Writes appeals, works with providers to obtain letters of medical necessity for appeal work, reviews records for medical necessity.
- Manages departmental correspondence, mail, and tracking spreadsheets.
- Cross trains to other roles within the department, in particular insurance review and case management.
- Develops front end education and training to related denials.
- Graduate of an accredited Associates or Bachelor’s Nursing program preferred. Training in Microsoft EXCEL highly preferred.
- At least 3 years of clinical experience. Experience with utilization management, disccharge planning, and third party payors preferred. Must be computer literate and have knowledge and understanding of psycho/social needs.
- Missouri or Compact State RN Licensure required.
- Case Management certification preferred.
- Considerable mental concentration. Ability to receive and express detailed information through oral and written communications. Excellent interpersonal and organizational skills. Lifting up to 35 lbs., turning activities and nearly constant walking required. Standing, turning, carrying, pushing, pulling, stooping, crouching, twisting, and reaching.
- Infrequent exposure to infectious disease and hostile persons at times. Frequent exposure to communicable disease via blood and other body fluids. Minimal physical discomfort.
