Revenue Cycle Medical Billing Resource Utilization Clinical Auditor

Revenue 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 air and ground ambulance transports, evaluation, and submission of all medical necessity appeals for commercial payors. Utilize clinical experience, established clinical standards and protocols to validate air medical necessity and appeal payment denials.

Essential Functions/ Duties

• Conduct audits of the medical necessity appeals for all payor sources in the role of advocate 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 all protected health information and cooperates fully with all information security guidelines related 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, Excel, Office 365

Education/Licensure:

• Current 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 Air Evac Lifeteam? As a leader in helicopter air ambulance services, Air Evac Lifeteam 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-keep care at the center, raise your hand, seek to understand, find a way together and be accountable-unite our teams and set us apart in emergency medical services.

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.

Check out our careers site benefits page to learn more about our benefit options.