RN Manager, Medical Review Unit

eFusion Partners
Sacramento, CA, US
Sep 12, 2017
Sep 22, 2017
Med / Surg
Contract Type
Job Description

Job description

Position Purpose: Manage the review of medical claims for billing coding and other compliance or reimbursement related issues, assist with non clinical aspects of the medical review and project management functions such as gathering information.
Manage the work flow of the medical review unit and assist with policy and procedure development and train staff.
Develop, implement and maintain production and quality standards for the medical review unit staff.
Oversight of standalone office location including daily personnel issues, supplies, staffing, and safety.
Investigate medical claims, records and other requested information for billing, coding, and other compliance or reimbursement related issues and make payment.
Receive and respond to inquiries and issues from the Claims Department regarding code review and appeals.
Maintain departmental database, correspondence and files.
Assess and categorize new Physicians Current Procedural Terminology (CPT), International Classification of Diseases (ICD) coding, government (HCPC) and home grown codes for information system configuration annually.

Education/Experience: Nursing degree and state registered nursing license with an advanced degree preferred. 3+ years nursing experience and 35 years of quality improvement and management experience in a healthcare environment, preferably managed care. Thorough knowledge of Physicians Current Procedural Terminology (CPT) and International Classification of Diseases, 9th Edition (ICD-9). Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

License/Certification: RN license.

Company Description

Where Opportunity and Talent Meet!
Our client is well established in the healthcare industry.
This is a unique opportunity to create and hire a team to support the company with firm wide visibility.

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