Responsible for auditing Medical charts against billed claims to resolve inquiries generated by insurance companies, (including Prompt Pay Statute Requests) patients, ACHA, OIG (Office of Inspector General), Compliance Office and other BHSF Departments. Assist with review and release of claims on the Bill Hold Report and back end resolution for denials Management. Serves as Liaison/resource for other BHSF areas for coding and charge entry.
Not ready to apply for a position yet? Click on this link, http://careers.baptisthealth.net/,
Registered Nurse, current Florida license, and/or BSN preferred. Experience in hospital acute care setting required. 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. Familiar with Compliance Regulatory AHCA guidelines preferred. 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.