Clinical Appeals Coordinator occupation at Lifespan Corporate Services in Providence

Lifespan Corporate Services is at present looking to employ Clinical Appeals Coordinator on Tue, 20 Aug 2013 13:33:09 GMT. Description : The Clinical Appeals Specialist reports to the Manager Appeals. Under general supervision and within Lifespan policies and procedures, works collaboratively with The Miriam Hospital and Rhode Island Hospital and multiple system-wide departments. Is responsible for review of medical records to ascertain appeal information and for the development of appeal correspondence. Analyzes...

Clinical Appeals Coordinator

Location: Providence Rhode Island

Description: Lifespan Corporate Services is at present looking to employ Clinical Appeals Coordinator right now, this occupation will be placed in Rhode Island. Detailed specification about this occupation opportunity please read the description below. Description : The Clinical Appeals Specialist reports to the Manager Appeals. Under general supervision and within Lifespan policies and pr! ocedures, works collaboratively with The Miriam Hospital and Rhode Island Hospital and multiple system-wide departments. Is responsible for review of medical records to ascertain appeal information and for the development of appeal correspondence. Analyzes clinical denials based on severity of illness and intensity of service using InterQual criteria and Center for Medicare and Medicaid Services (CMS) guidelines. Analyzes and reports data of audits at the facility and system-wide level. Provides education to Lifespan staff and physicians to reduce future audit exposure.
Qualifications : Must have current licensure to practice as a Registered Nurse in the State of Rhode Island or in another state that participates in the Nurse Licensure Compact. Bachelor’s Degree in Nursing, Health Science or Health Business required, Master’s Degree preferred. Three years or more of relevant recent clinical and/or administrative experience in medical/surgical nursing; two yea! rs of which must be related to utilization review activities, ! demonstrating organizational skills and ability to make sound clinical judgment. Working knowledge of level of care criteria is required. Knowledge of state and federal regulations is desirable.
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This occupation starts available on: Tue, 20 Aug 2013 13:33:09 GMT

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