Coord - Util Review Pre Access

  • Mission Health System
  • Asheville, NC, USA
  • Apr 21, 2018
Healthcare

Job Description


JOB SUMMARY: Provides clinical information to all payers as required by contract, rules or regulations. Reviews assigned hospital scheduled services to ensure proper prior authorization is documented for billing compliance. Works cooperatively with the Physician Offices and Referral Sources to facilitate necessary peer-to-peer clinical reviews, correct coding and documentation for orders as required by Mission Health System and CMS regulations. Maintains open communications with referring providers. Demonstrates excellent understanding of clinical documentation in all supported electronic medical record systems.

REQUIRED EDUCATION: RN, LPN or Business Degree

PREFERRED EDUCATION: None

REQUIRED LICENSE: RN, or LPN

PREFERRED LICENSE: Maintains nationally recognized certification, such as CCM, ACM, ANCC Nursing Case ManagementRN-BC or CPHM

REQUIRED EXPERIENCE: Clinical background in Nursing, related field, or business background and preferable experience in insurance and pre-certification. Ability to read, analyze, and interpret written materials, financial reports and legal documents. Ability to communicate effectively, verbally and in writing with peers, customers, staff, physicians and other agencies. Basic knowledge of computers and data entry.

PREFERRED EXPERIENCE: 3 years in a hospital or physician's office as a nurse, coder, biller, or working with insurance claims. Knowledge of Mission and Mission Practice Management Systems; PowerChart and PowerChart Ambulatory