Registered Nurse - phrn / usrnCotiviti

RN - USRN / PHRN
 
We are currently seeking USRN / PHRN to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The RN is responsible for analyzing and
interpreting and assign the correct codes for the descriptions available on various medical
procedures and diagnosis and other related medical coding as per the medical policy
requirements
 
JOB RESPONSIBILITIES
• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement
• Respond to provider appeals
• Respond to client logics and record reviews
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations
• Reports his/her work performance on a timely basis to the team lead
• Works diligently to meet and exceed productivity and quality benchmarks
• Takes charge of ongoing learning and development and participates in relevant training and development activities
• Willing to work in US hours during training, which may last for 8 to 12 weeks. Thereafter shift
timing will overlap US working hours for couple of hours, based on business requirements
• Required to work from office
 
 
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS
➢ Nursing degree mandatory
➢ Registered Nurse with CIC/CCS certification and prior auditing/DRG experience preferred
➢ Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred
➢ Possesses knowledge of healthcare claims payment policy and processing -specifically CMS, Medicaid regulations, ICD-10 CM & DRG Expert, etc.
➢ Practical clinical experience working in a hospital/office or nursing home
➢ Has general knowledge of medical procedures, conditions, illnesses, and treatment practices
➢ Possesses excellent written and verbal communication skills. Ability to think logically
and process sequentially with a high level of detailed accuracy and efficiency
➢ Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.