"Responsible for handling administrative and medical appeals that require clinical input or interpretation, directing and coordinating all aspects of denied claims, provide coordination of comprehensive clinical documentation to third-party payers and state agencies to secure accurate payment, and the ability to identify coding or clinical documentation issues. "
Responsibilities
- Analysis and Recommendations
- Provides on-going trend analysis to identify reasons for denials and apply corrective actions steps to prevent cash flow retardation.
- Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Responsible for facilitating the internal appeal process.
- Actively works through denied claims and attempts to gather information and take appropriate action to ensure claim is adjudicated properly.
- Quality
- Promotes the quality and efficiency of his/her own performance through participation in staff educational programs, approved continuing education courses, and specialized skill training programs.
- Utilizes all equipment, supplies, facilities, and resources in a prudent and efficient manner in order to ensure efficient departmental operations and the provision of high-quality health care services.
- Other Duties as Assigned
- Performs other duties as assigned or requested.
Qualifications
Education - Graduate of accredited school of nursing
Licensure - Current Louisiana State license as RN
