Responsible for utilization chart reviews and approving claims for release from the Bill Hold Report. Assist with review of Medical record documentation to resolve inquiries generated by insurance companies, patients, and administration. Serves as Liaison for Denials Management and Bill Hold Release with other BHSF department.
Registered Nurse, current Florida license, and/or BSN preferred. Experience in the field of Utilization Management. Medical Chart Auditing Experience Required Knowledge of Observation Stay Regulations; One and Two Day Admissions; Roll Overs; ICD-9, CPT-4 and HCPCS coding; CMS 1500 and UB-92 Forms. Certification in Professional Healthcare Management preferred. Familiar with Compliance Regulatory AHCA guidelines required Knowledge and interpretation of Statutory Guidelines and Carrier Contracts relating to Denials Management preferred Experience using health care web based applications. Excellent verbal and written communication skills. Working knowledge of intensity of service, severity of illness criteria and Medicaid Kepro guidelines. Inter-Qual experience required. Skilled in Microsoft Office Professional Applications.