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Job Details

Prebill Denials RN

Company name
HCA Management Services, LP

Location
Houston, TX, United States

Employment Type
Full-Time

Industry
Healthcare, Nursing

Posted on
Jul 10,2019

Valid Through
Oct 23,2019

Apply for this job






Profile

GENERAL SUMMARY OF DUTIES

The Prebill Denial Nurse will review post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures. Escalate medical review request and/or denial activities to management as needed

**

SUPERVISOR – SSC Denial Director

SUPERVISES – NA

*Functional areas:*

* Obtain authorizations for post discharge, prebill accounts_

_

* Perform re-certification for additional days on post discharge, prebill accounts_

_

* eRequest queues as determined during program implementation

_OPERATIONAL DUTIES INCLUDE BUT ARE NOT LIMITED TO:_

Work post discharge, prebillaccountsefficiently and effectively on a daily basis to resolve accounts with “no auth numbers, ALOS vs. authorized days or other discrepancies

Evaluates clinical documentation on multiple patient accounts and escalates issues through the established chain of command

Perform accurate and timely documentation of all review activities based on policy and procedure

Demonstrates a working knowledge of managed care agreements based on available resources which may include and not be limited to payer UM Manual, policy and procedure, facility contract information. Escalates variations timely.

Work assigned accounts in eRequest to resolve outstanding issues

Report insurance denial trendsidentified during daily operational assignments

Contact facilities, physicians’ offices and/or insurance companies to resolve denials/appeals if needed

Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives.

Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous

Communicates effectively and professionally with physicians, hospital staff, and outside agencies

Adhere to all policies and procedures, including, attendance, phone and internet usage, break utilization, etc.

Participate in education and training as needed

Establish and maintain relationships with all customers

Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous

Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely

Demonstrates commitment to teamwork and cooperation

Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”

Other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES

Communication –ability to communicate effectively in oral, written and electronic formats

Customer orientation -establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations**

Interpersonal skills –ability to establish and maintain collaborative and effective working relationships

PC skills –demonstrates proficiency in Microsoft Office applications and others as required

Policies & Procedures -demonstrates knowledge and understanding of organizational policies, procedures and systems**

Basic skills– demonstrates an ability to organize, perform and track multiple tasks accurately in short timeframes of one continuously scheduled shift or less and have ability to work quickly and accurately in a fast-paced environment while managing multiple demands

Clinical skills –ability to read/ interpret medical record documentation and present the clinical data obtained in an organized, concise dialogue to the payor in order to obtain auth and/or resolve other issues.

EDUCATION

Associate’s Degree or higher preferred

EXPERIENCE

*

Utilization Review, appeals, denials, managed care contracting, experienced preferred

CERTIFICATE/LICENSE– RN or LPN/LVN with current state licensure

PHYSICAL DEMANDS/WORKING CONDITIONS-Requires prolonged sitting, some bending,stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.

Job: *Case Management

Title: Prebill Denials RN

Location: Texas-Houston-Prebill Denial – Houston

Requisition ID: 26515-166339

Company info

HCA Management Services, LP
Website : http://hcahealthcare.com

Company Profile
At its founding in 1968, Nashville-based HCA was one of the nation's first hospital companies. Today, we are the nation's leading provider of healthcare services, a company comprised of locally managed facilities that includes about 165 hospitals and 115 freestanding surgery centers in 20 states and England and employing approximately 204,000 people. Approximately four to five percent of all inpatient care delivered in the country today is provided by HCA facilities. Milton Johnson serves as Chairman and Chief Executive Officer of HCA. HCA is committed to the care and improvement of human life and strives to deliver high quality, cost effective healthcare in the communities we serve. Building on the foundation provided by our Mission & Values, HCA puts patients first and works to constantly improve the care we give them by implementing measures that support our caregivers, help ensure patient safety and provide the highest possible quality. Investing in our communities is important to us. HCA typically invests about $1.5 billion annually to keep our facilities modern and up-to-date technologically and to expand and add services where needed. Focusing primarily on communities where the company is a leading healthcare provider, HCA selectively adds new facilities in order to better serve our communities. And because two HCA founders were physicians, we value highly the strong relationships we've created with local physicians. We endeavor to provide them with a wide array of services and modern facilities in order to help them deliver the best possible care.

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