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Kootenai Health - Coeur d'Alene, ID
posted about 2 months ago
About the position
The Revenue Cycle Nurse Coordinator is responsible for managing clinical appeals and ensuring compliance with regulatory requirements related to medical necessity and benefit determinations. This role involves leadership in identifying trends for process improvement, supporting denial resolution, and facilitating referrals and authorizations for clinical procedures. The position requires collaboration with various stakeholders to enhance workflow processes and improve the overall revenue cycle.
Responsibilities
- Utilize nationally recognized criteria sets and author clinical appeals to secure recovery of denied dollars.
- Provide leadership by communicating trends to clinical department leadership for process improvement opportunities.
- Ensure compliance with regulatory requirements related to Medicare, Medicaid, and commercial payers.
- Support denial resolution across the organization, including hospitals and clinics.
- Assist in the facilitation of referrals, authorizations, and financial clearance for clinical procedures.
- Contact payers and providers for assistance in rescheduling practices and gathering medical information.
- Prepare medical cases for payer peer-to-peer review.
- Assist with communication and training initiatives related to referral/pre-authorization performance improvement.
- Collaborate with internal and external stakeholders to assess workflow processes and implement changes for timely authorizations.
- Recognize out-of-the-ordinary situations and work with stakeholders to improve processes.
Requirements
- BSN required, MSN preferred.
- State of Idaho Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the 'multistate privilege to practice' compact with Idaho.
- Minimum 3 years' clinical practice experience required.
- Prior experience with regulatory requirements for medical necessity for all payers preferred.
- Strong interpersonal skills and proven ability to function in a confidential and highly responsible manner.
- Excellent computer skills and ability to learn multiple electronic medical record systems, including Excel, Word, and PowerPoint.
Nice-to-haves
- Experience in Microsoft PowerPoint.
- Experience with electronic medical record systems.
Benefits
- Dental insurance
- Health insurance
- Retirement plan
- Tuition reimbursement
- Vision insurance
- Wellness program
