Clinical Appearls Coordinator-PT

Hello

Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application:

• Provide all of your employment history education and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it.
• You must meet all of the job requirements at the time of submitting the application.
• You can only apply one time to a job requisition.
• Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process.
• Applications must be submitted prior to the close of the recruitment. Once recruitment has closed applications will no longer be accepted.

After you apply we will review your qualifications and contact you if your application is among the most highly qualified. Due to the large volume of applications we are unable to individually respond to all applicants. You may check the status of your application via your Candidate Profile.

Thank you

Human Resources

Important Applications Instructions:

Please complete this application in entirety by providing all of your work experience education and certifications/

license. You will be unable to edit/add/change your application once it is submitted.

Job Requisition ID:

Job Category:

Organization:

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Job Summary:

Education & Experience

Education and Experience Required:

Two (2) years of nursing experience.

Certifications Licenses or Registration required:

Valid RN license.

Preferred Qualifications:

Utilization review and case management experience.

Knowledge Skills & Abilities

Knowledge Skills and Abilities:

Knowledge and understanding of clinical organization structure workflow and operating procedures. Skill in the use of personal computers and related software applications. Ability to manage multiple priorities under time constraints; ability to analyze and solve problems. Understanding cost and quality issues. Verbal and written communication skills. Interpersonal skills to interact with a wide range of constituencies. Decision-making skills.

Responsibilities

• Reviews patient medical records and collects data to support billing and appeals management analysis and monitoring activities.
• Communicates with insurers to determine the appropriateness of payments or denials.
• Collects reviews and submits timely appeals for medical necessity and authorization of denials.
• Conducts clinical research and analysis to identify issues and develop strategies that improve the payment and appeals process.
• Assists with chart audits by reviewing and comparing medical records against itemized patient bills to ensure accuracy and maintain revenue integrity.
• Analyzes denial and payment data to identify trends and patterns supporting system-wide performance improvement and management education.
• Supports quality improvement initiatives by reviewing clinical practices for consistency adherence to policy and appropriate levels of care across settings; prepares reports and communicates findings to clinical and non-clinical staff.
• Communicates and negotiates with external stakeholders including insurance payers regarding appeal outcomes.
• Maintains knowledge of current regulatory and accreditation standards related to denial and appeals management to support organizational compliance.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold occasional exposure to bio-hazardous conditions such as risk of radiation exposure blood borne pathogens fumes or airborne particles and/or toxic or caustic chemicals which mandate attention to safety considerations occasional working hours significantly beyond regularly scheduled hours occasional travelling to offsite locations occasional work produced subject to precise measures of quantity and quality occasional bending occasional lifting and carrying up to 25 pounds occasional crouching/stooping occasional kneeling occasional pushing/pulling frequent reaching frequent sitting frequent standing occasional twisting and frequent walking. (occasional-up to 20% frequent-from 21% to 50% constant-51% or more)

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Benefits Eligibility:

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Job Closing Date (open until filled if no date specified):