Seeking Registered Nurse Background!

Description

A well-known healthcare client in the Hopkins, MN area is seeking a Registered Nurse background. This is a great opportunity to transition into an office-related position.

Pay: $30.00-32.00/hr

Hours: M-F, full-time

Location: 100% remote (NEED TO BE LOCAL TO MN)

Job Description:

+ Responsible for the pre and post payment auditing of high dollar healthcare claims to ensure accurate adjudication by applying medical coding and billing guidelines, reimbursement methodologies and clinical knowledge. Negotiates non participation provided rates.

+ Applies clinical background, knowledge of provider medical claim billing practices and standard claims payment protocol to support Payment Integrity (PI) goals with an over-arching goal of paying claims timely and accurately. Audits high dollar and other subsets of claims to limit waste and abuse or other behaviors that conflict with payment intent, coverage policies and/or coding requirements.

+ Uses claims payment data to detect, analyze and validate manual and/systematic errors in claims adjudication based on payment intent and payment policy guidelines

+ Performs provider negotiation functions and create letters of agreement.

+ Works collaboratively with key internal partners, customers and external vendors to establish shared business goals and road maps.

Requirements

Knowledge/skill:

+ Bachelor's degree or equivalent experience in related field, plus 7 years of work experience beyond degree.

+ Required: Registered Nurse (RN) active License

+ Preferred: Certified Professional Coder (CPC) certified (nice-to-have)

+ Advanced working knowledge and skill of professional field with ability to function as a subject matter expert for other staff.

Soft Skills:

+ Customer Service focused

+ Comfortable on the phone and negotiating with (Medical) Providers

+ Works well independently and as a team.

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