Georgia Employer UTILIZATION MANAGEMENT NURSE UTILIZATION MGMT EXPR in Norcross, Georgia
Job Code: 26512-136304 Part-time No Weekends Parallon, a leading health care company is offering a great opportunity. We are looking for dynamic candidates to be part of our team. We offer excellent relocation and benefit packages, including 401K, bonus potential, tuition reimbursement, medical and dental plans, flexible spending plans, long-term/ short -term disability, and generous paid time off! The Prebill Denials 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 DUTIES (INCLUDED BUT NOT LIMITED TO): * Work post discharge, prebill accounts efficiently 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 trends identified 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 * Employer's Job# 26512-136304Please visit job URL for more information about this opening and to view EOE statement.