Nurse Coordinator – PreServices

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Develop and deliver professional nursing services in line with nursing standards, educational background, experience, Ohio nursing regulations, and established policies.

• Analyze pre/post service initial denials.

• Obtain escalated insurance authorizations.

• Manage escalated medical necessity assessments.

• Collaborate with Patient Access, Mid-Revenue Cycle, and Patient Business Service to uncover opportunities for revenue enhancement and denial prevention.

• Work in partnership with physician providers to synchronize proposed service intensity with illness severity and support level-of-care evaluations and authorizations.

• Examine denials and identify root causes.

• Monitor and report denial trends to assist in remediation and enhance internal processes.

• Investigate and apply regulatory policies to bolster administrative appeals.

• Oversee denial management activities, encompassing administrative/technical accounts and operational write-offs.

• Track initial denials and engage with Patient Access and Revenue Cycle colleagues on education and stakeholder reporting.

• Uphold necessary competencies, licenses, and certifications while fostering the learning and development of others.

⛳️ Requirements

• Graduation from a recognized school of nursing.

• Valid Ohio RN license.

• 1-2 years of experience with technical and/or clinical denials, including medical necessity, eligibility concerns, and lack of authorization.

• Familiarity with medical terminology.

• Experience in medical record coding, including ICD-10 and CPT/HCPCS.

• Understanding of insurance and governmental programs, regulations, and billing procedures, including Medicare, Medicaid, managed care agreements, and coordination of benefits.

• Bachelor's degree is preferred.

• Certification and/or membership in AAPC, AHIMA, HFMA, AAHAM, or NAHAM is preferred.

• Proficiency in Epic Prelude and Resolute is preferred.

• Knowledge and experience in case management/utilization management and managed care contracts is preferred.

🏝️ Benefits

• Medical, dental, and vision coverage available from day one.

• Retirement savings account with employer matching starting on day one.

• Generous paid time off policies.

• Employee recognition initiatives.

• Tuition/professional development reimbursement available from day one.

• Full RN to BSN tuition coverage at Mount Carmel’s College of Nursing.

• Relocation assistance (certain geographic and position restrictions apply).

• Employee Referral Rewards program.

• DailyPay, enabling eligible employees to access earned wages before payday.

• Diversity, Equity, and Inclusion Colleague Resource Groups.