RESPONSIBILITIES:
- Provide health care services regarding admissions, case management, discharge planning and utilization review.
- Review admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
- Assist with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
- Notifies attending physician and other members of the health care team of inappropriate admissions, denials, end of authorized days, or other factors that have a reimbursement impact.
- Consults with attending physician when documentation in the medical record does not support admission or continued stay and seeks to ensure completeness of all clinical documentation.
- Functions as liaison between the Physician Advisor and the attending physician.
- Documents denial information in electronic medical record system including attempts at resolution/overturning of the denial.
- Provides all payor communication to be scanned into the system for use in appeals.
- Conveys and receives information efficiently to and from third party payors, physicians, patients/families, physician practices, other members of the health care team, and other external agencies.
- Consults with medical and treatment staff regarding client diagnosis, medical justification, length of treatment, and case documentation.
- Participates in utilization and peer review meetings and projects.
COMPETENCIES, SKILLS AND OTHER REQUISITES:
- Licensed Practical Doctor
- Excellent written and spoken English
- Unflinching integrity and personal work ethics
- Self-starter who strives for self and team excellence
- Flair for client satisfaction
- Attention to detail and concern for accuracy
- Excellent time management skills and multi-tasking ability
- Excellent team player
- Compliant to rules and regulations
Tipo de puesto: Tiempo completo
Sueldo: Hasta $23,000.00 al mes
Pregunta(s) de postulación:
- ¿Cuentas con título universitario concluido y licencia al día?
Idioma:
- inglés avanzado (Obligatorio)