LCMC Health
Hospital Audit and Appeals Nurse (Hybrid)
LCMC Health, New Orleans, Louisiana, United States, 70123
Overview
Hospital Audit and Appeals Nurse (Hybrid) role at
LCMC Health . This position reports to the Audit and Appeals Supervisor and focuses on audits and appeals for government and commercial payers to improve revenue by evaluating clinical and financial processes from patient care to final bill generation. It requires strong interpersonal, analytic and organizational skills and the ability to meet deadlines while influencing, but not directly managing, others. Responsibilities
Manage payer denials by conducting retrospective analytical review of clinical documentation to determine if an appeal is warranted in a timely manner Exercise discretion and independent judgment when completing medical record quality audits and preparing appeal arguments with the appropriate department, relating to payer policy/procedure, contract agreements and regulatory requirements Research and analyze the RRL (review result letters) for government and third-party payer denials related to DRG Assignment, Medical Necessity, Level of Care, and Clinical Authorizations; provide supporting documentation for audit and appeal to pursue resolution through all appeal levels; monitor pre-billing and post-billing to assist in ensuring accurate reimbursement Follow up communication with physicians and other provider personnel to ensure documentation supports submitted charges; work with the Audit and Appeals coordinator to complete the appeals process Collaborate with Compliance, Case Management, Coding, Patient Access, Managed Care Contracting, Central Business Office, Health Information Management, Finance and Clinical departments to resolve Audit and Appeal trends and other issues; participate in revenue cycle initiatives Qualifications
Experience: 5 to 8 years in healthcare finance, revenue cycle management, patient accounting and physician billing, coding and documentation Education: Required bachelor’s degree in Healthcare Licenses and Certifications
Certified Professional Coder-Hospital (CPC-H) – American Academy of Professional Coders (required, entity: LCMC) Certified Professional Coder (CPC) – AAPC (required, entity: LCMC) Certified Coding Specialist (CCS) – CCHIIM (required, entity: LCMC) Certified Coding Specialist – Physician-based (CCS-P) – CCHIIM (required, entity: LCMC) Registered Nursing License – Louisiana State Board of Nursing (entity: LCMC) Licensed Respiratory Therapist – State Board of Medical Examiners (entity: LCMC)
Skills and Abilities
Knowledge of CPT/HCPCS, ICD-10 and related edits (e.g., NCCI); familiarity with EHR and health information systems; understanding of IPPS, OPPS and Managed Care; strong computer skills (MS Office: Word, Excel, PowerPoint); excellent oral and written communication; strong research and detail orientation; ability to interpret regulatory standards Preferred: knowledge of insurance guidelines (MA, MC, Commercial, MCO, HMO); experience with case management or utilization review Electronic Health Systems experience Work Shift
Days (United States of America) About LCMC Health
LCMC Health is an equal opportunity employer. Our people are dedicated to bringing the best possible care to every person and parish in Louisiana and beyond. We reserve the right to amend and change responsibilities as necessary. Why join
Deliver healthcare with heart Give people a reason to smile Bring compassion and integrity to your work One-of-a-kind care Collaborative and forward-thinking environment
#J-18808-Ljbffr
Hospital Audit and Appeals Nurse (Hybrid) role at
LCMC Health . This position reports to the Audit and Appeals Supervisor and focuses on audits and appeals for government and commercial payers to improve revenue by evaluating clinical and financial processes from patient care to final bill generation. It requires strong interpersonal, analytic and organizational skills and the ability to meet deadlines while influencing, but not directly managing, others. Responsibilities
Manage payer denials by conducting retrospective analytical review of clinical documentation to determine if an appeal is warranted in a timely manner Exercise discretion and independent judgment when completing medical record quality audits and preparing appeal arguments with the appropriate department, relating to payer policy/procedure, contract agreements and regulatory requirements Research and analyze the RRL (review result letters) for government and third-party payer denials related to DRG Assignment, Medical Necessity, Level of Care, and Clinical Authorizations; provide supporting documentation for audit and appeal to pursue resolution through all appeal levels; monitor pre-billing and post-billing to assist in ensuring accurate reimbursement Follow up communication with physicians and other provider personnel to ensure documentation supports submitted charges; work with the Audit and Appeals coordinator to complete the appeals process Collaborate with Compliance, Case Management, Coding, Patient Access, Managed Care Contracting, Central Business Office, Health Information Management, Finance and Clinical departments to resolve Audit and Appeal trends and other issues; participate in revenue cycle initiatives Qualifications
Experience: 5 to 8 years in healthcare finance, revenue cycle management, patient accounting and physician billing, coding and documentation Education: Required bachelor’s degree in Healthcare Licenses and Certifications
Certified Professional Coder-Hospital (CPC-H) – American Academy of Professional Coders (required, entity: LCMC) Certified Professional Coder (CPC) – AAPC (required, entity: LCMC) Certified Coding Specialist (CCS) – CCHIIM (required, entity: LCMC) Certified Coding Specialist – Physician-based (CCS-P) – CCHIIM (required, entity: LCMC) Registered Nursing License – Louisiana State Board of Nursing (entity: LCMC) Licensed Respiratory Therapist – State Board of Medical Examiners (entity: LCMC)
Skills and Abilities
Knowledge of CPT/HCPCS, ICD-10 and related edits (e.g., NCCI); familiarity with EHR and health information systems; understanding of IPPS, OPPS and Managed Care; strong computer skills (MS Office: Word, Excel, PowerPoint); excellent oral and written communication; strong research and detail orientation; ability to interpret regulatory standards Preferred: knowledge of insurance guidelines (MA, MC, Commercial, MCO, HMO); experience with case management or utilization review Electronic Health Systems experience Work Shift
Days (United States of America) About LCMC Health
LCMC Health is an equal opportunity employer. Our people are dedicated to bringing the best possible care to every person and parish in Louisiana and beyond. We reserve the right to amend and change responsibilities as necessary. Why join
Deliver healthcare with heart Give people a reason to smile Bring compassion and integrity to your work One-of-a-kind care Collaborative and forward-thinking environment
#J-18808-Ljbffr