Registered Nurse (RN) - Med Surg
Genesis Healthcare LLC
Philadelphia, PA

Reimbursement Appeals Nurse

POSITION SUMMARY: Assists the denial management team by conducting a comprehensive analytical review of patient's medical records. Appeal Writer/ Reimbursement Analyst will write sound, sensible and factual arguments that clearly argue for payment of the services provided. Specific reasons for denials are to be addressed directly with justification for the services to be paid. RESPONSIBILITIES/ACCOUNTABILITIES: Reviews patient medical records; utilize clinical, regulatory knowledge and skills to provide convincing appeal arguments as to why a claim should be paid. Identifies and reports trends in charts that are resulting in denials. Identifies regulatory changes or trends in appeal decisions that may be in breach of published regulations or payer policy guidelines. Uses clinical evidence and/or regulatory arguments to prove appeal reasoning. Participates in Administrative Law Judge hearings by providing testimony as necessary. Requests additional supporting clinical evidence to support appeal arguments when existing resources are inadequate for justifying services. Proficiently reads and understands abstract information from handwritten patient medical records. Reviews large amounts of information (medical records) and determine what is necessary to support an appeal. Requests late entry documentation as needed. Ensures compliance with HIPPA regulations. Familiar with the various Attestation templates, ability to prepare them correctly as requested. Familiar with the various MAC's and their LCD's. Ability to articulate decision to appeal or waive an appeal to department lead/manager with support to validate next action. As needed, facilitates communication with designated billing/business offices in support of Denials Management process. Provides regulatory and payer policy guidance for appeal requests at all levels. Maintains tracking records of appeals management activities in accordance with department policies Performs other duties as requested. Qualifications: Registered Nurse. Significant experience in the Healthcare Industry. Knowledge of regulatory requirements for reimbursement and reasons for denials. Other Info * Position Type: Full Time * Pay Target: $80,000-$95,000 / year * Job City: Philadelphia * Requisition Number: 509426