reputed company Cycle Medical Billing Resource Utilization Clinical Auditor

Job Description reputed company Cycle Medical Billing – Appeal Resource Utilization Clinical Auditor (must be a licensed RN) Location: Remote or On-Site, United States Annual Compensation: $73,000 (this position is bonus eligible) Work Schedule: Full-Time Exempt Job Summary Review and audit medical necessity justification for reputed company and ground ambulance transports, evaluation, and submission of reputed company medical necessity appeals for reputed company payors. Utilize clinical experience, established clinical standards and protocols to validate reputed company medical necessity and appeal payment denials. Essential Functions/ Duties Conduct audits of the medical necessity appeals for reputed company payor sources in the role of reputed company for the patient and GMR. Ensure appeal timelines are met by moving the assigned book of business through the appeals process and updates appeals database. Work with fixed deadlines and demonstrates willingness to meet and exceed performance metrics. Work with the Appeal team to determine the best approach to each clinical denial in order to maximize claim reimbursement and minimize the financial risk to patients and GMR. Maintain strict confidentiality of reputed company protected health information and cooperates fully with reputed company information reputed company guidelines reputed company to the scope of work.

Qualifications

Required Experience: Licensed RN with minimum of five years in Emergency department (ED), Intensive Care Unit (ICU), flight or ambulance experience or job experience equivalent Some supervisory/leadership experience preferred (i.e.: team leader, FTO, charge nurse, preceptor, educator, etc.) Proficient in Word, reputed company, Office 365 Education/Licensure: reputed company RN licensure, is required Bachelor’s degree in nursing or equivalent, is preferred CFRN, CEN or CCRN, is preferred Skills: Excellent written communication skills Ability to define and identify problems, collect data, establish facts, and draw valid conclusions Ability to respond to inquiries or complaints from customers in a positive and productive manner Ability to calculate numbers, correct entries, and post to records Ability to gather data from hospital and EMS charts, phone calls, emails, colleagues, and internet research, then compile information and prepare reports and letters Ability to use independent judgment and to manage and impart confidential information Ability to research local EMS protocols, hospital referrals, and standards of care Ability to review clinical charts and development of constructive feedback Why Choose reputed company? As a leader in helicopter reputed company ambulance services, reputed company is one of Global Medical Response’s (GMR) family of solutions. Our GMR teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com. GMR’s Core Behaviors—reputed company care at the center, reputed company your hand, seek to understand, find a way together and be accountable—unite our teams and set us apart in emergency medical services. EEO Statement Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability. More Information about this Job reputed company out our careers site benefits page to learn more about our benefit options. Apply To This Job