Job DescriptionThis positionreflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. This position works to recover lost revenue as a result of post payment denials and to perform charge / record audits received from the government or other third party agencies.
Responsibilities:- Using clinical knowledge and evaluation of documented patient treatments, this position receives, interprets and facilitates appeals on insurance denials post payment, including payer escalation and other escalation methods to secure payment.
- This position is responsible for management of audits, including those from the Centers of Medicare & Medicaid Services (CMS).
- This position provides financial data and analysis for internal and external reporting and ensures the hospital is prepared for audits and responds to all audit requests.
QualificationsRequired:- Licensed Registered Nurse (Current)
- Minimum of 3 years in Acute Care Setting or in Audit / Appeals position.
- Working knowledge of Miliman/ Interqual quidelines
- Ability to analyze data; strong communication skills and ability to work cross functionally with other departments.
Preferred:- BSN in Nursing
- Knowledge of Medicare reimbursement policies
BenefitsWe offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.
