Denial Prevention Nurse Consultant

At Revecore, our work helps hospitals recover the revenue they've earned so they can continue serving patients and communities. Trusted by more than 1,300 hospitals across 48 states, we combine specialized expertise with proprietary technology to solve problems others can't. Just as importantly, we've built a workplace where people support one another, embrace innovation, and are trusted to do their best work.

The Role: Denial Prevention Nurse Consultant

Primarily responsible for thorough review of medical records and other medical documentation to determine appropriate billable services for hospital to construct an appeal for payment based on medical necessity or payer specific guidelines or criteria. Responsible for providing clients trending, revenue cycle fail point analysis, and best practice remediation recommendations.

Training:

Our comprehensive training begins on your first day and lasts 90 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences.

As a Denial Prevention Nurse Consultant, you will:

• Build strong, lasting relationships with clients, payors and Revecore personnel

• Analyze medical records or other medical documentation to validate services, tests, supplies and drugs performed for accuracy related to billing for services rendered

• Identify and interpret medical, radiological, laboratory or other tests and procedures as well as pharmaceutical drugs

• Review and understand managed care contracts, hospital billing statements/bills and insurance denials

• Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims.

• Perform research regarding denials and effectively communicate information to associates, colleagues, managers and clients

• Contact insurance company to obtain missing information, explain and resolve underpayments and/or denials and arrange for payment or adjustment processing on behalf of client

• Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting

• Perform denial trending for clients, identify fail points within the revenue cycle and on the payer side, and provide best practice recommendations to clients and Revecore managers.

• Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnel

• Maintain confidentiality of information in compliance with company policy and HIPAA

• Attend client, department and company meetings

• Lead client meetings and perform consulting services to client's as it relates to medical necessity of services performed and proper vetting of payers criteria

Is this role for you?

Revecore encourages our employees to be driven and highly motivated to be successful. We get excited by candidates who:

• College degree or diploma from school of nursing -- must be RN

• Clinical nursing experience working in hospital environment, preferably in ER, Critical Care or diagnostic services

• Minimum 5 years of related experience and/or training in utilization review or patient accounting

• Are highly proficient with Interqual and MCG guidelines and demonstrate appropriate application to claim appeal argument.

• Understand patient accounting documents -- UB04, EOB

• Have a working knowledge of Microsoft Office (Word, Excel, Outlook)

• Possess technical proficiency to work on multiple computer screens and software applications simultaneously

• Are able to read and interpret an extensive variety of documents such as medical records, patient care systems, instructions, policies and procedures in written (in English) and diagram form

• Can maintain strong performance in a fast-paced environment with productivity metrics

• Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies

• Have experience with healthcare billing software and databases (EPIC, Cerner, Meditech)

How we'll set you up for success:

• Extensive multi-week training with ongoing support from teammates following training.

• Access to a robust knowledgebase for continued reference in your role.

• Visibility to your individual performance metrics enables you to set goals.

• Computers and necessary work equipment are provided

• Involved management who leans in to support your productivity metrics.

Work at Home Requirements:

• A quiet, distraction-free environment to work from in your home.

• A secure internet connection is required.

• Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.

• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.

Must reside in the United States within one of the states listed below:

Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (CST Time Zone), Tennessee, Texas (CST Time Zone), Vermont, Virginia, Wisconsin, and West Virginia.

Revecore is an Affirmative Action/Equal Opportunity Employer committed to providing equal employment opportunities for all applicants and employees. We make employment decisions without regard to any characteristic protected by applicable law and encourage individuals of all backgrounds to apply.

Employment is contingent upon eligibility to work in the United States, verification of employment history, and successful completion of a background check.