
Clinical Nurse Specialist
3 days ago
Job Overview
- Process inpatient and surgical bills according to standard operating procedures (SOP) and turnaround time.
- Perform bill review using appropriate resources, clarifying discrepancies to recommend reimbursement.
- Document pertinent information in the system bill notes to support reimbursement determination.
- Reconsider bills as requested to ensure original processing determination is appropriate.
- Collaborate objectively with peer physicians for reimbursement determination.
- Demonstrate knowledge of medical department policies and procedures, communicating them as necessary.
- Assist personnel and concerned departments with billing issues and inquiries on fee schedules and/or ground rules.
- Communicate effectively with case management personnel and liaise with attorneys as needed.
- Referral matters beyond limits of authority to immediate superior.
- Uphold confidentiality by protecting information and perform other related tasks as required.
Candidates must have a Bachelor's degree in Nursing, an active RN license, and at least one year of diverse clinical experience or prior experience in medical bill review or claim/case review. Strong communication and analytical skills, proficiency in word processing software, and ability to multi-task are essential.
Qualifications:- Bachelor's degree in Nursing.
- Active and unrestricted RN license.
- Minimum one year diverse clinical experience or prior experience in medical bill review or claim/case review.
- Good communication and analytical skills.
- Proficient in word processing software applications.
- Maintains high professionalism and confidentiality.
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