Performs Utilization Review function for Capital Health related to third party reimbursement, denials, appeals and clinical audits for inpatient cases.
Pay Range:
$86,964.80 - $113,672.00
- Monitors inpatient utilization process and ensures that process is performed adequately on all inpatients in accordance with applicable standards, regulations and payer contracts.
- Actively supports denial and appeal process for the department.
- Interfaces with Health Information Management (HIM) and billing departments to coordinate clinical components to ensure appropriate reimbursement.
- Performs accurately chart and utilization review audits as directed.
- Supports Capital Health Utilization Committee with analysis of clinical outcomes data.
- Graduation from an accredited School of Registered Nursing
- Nice to have: inpatient denial appeal experience
Hospital Coding Specialist IIIWest Tennessee Healthcare · Jackson, US