US Registered Nurse (umr mcg) | wfh | 50k sign-on bonus!Omega Healthcare Management Services Inc.

OMEGA HEALTHCARE MANAGEMENT SERVICES INC.
 
Is currently looking for:
 
US REGISTERED NURSE (UMR MCG)
 
Duties & Responsibilities:
Work post discharge, prebill accounts efficiently and effectively on a daily basis to resolve accounts with "no auth numbers, ALOS vs. authorized days or other discrepancies 
Evaluates clinical documentation on multiple patient accounts and escalates issues through the established channels
Perform accurate and timely documentation of all review activities based on policy and procedure
Demonstrates a working knowledge of managed care agreements based on available resources which may include and not be limited to payer UM Manual, policy and procedure, facility contract information. Escalates variations timely. 
Work assigned accounts in eRequest to resolve outstanding issues
Report insurance denial trends identified during daily operational assignments 
Contact facilities, physicians' offices and/or insurance companies to resolve denials/appeals if needed 
Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors self‐compliance and implements process changes to ensure compliance to such regulations and quality initiatives. 
Assess CPT code(s) for outpatient accounts that require authorization when accounts have not been coded 
Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous 
Communicates effectively and professionally with physicians, hospital staff, and outside agencies
Adhere to time and attendance policies 
Adhere to all policies and procedures, including,  phone and internet usage, break utilization, etc. 
Participate in education and training as needed
Establish and maintain relationships with all customers 
Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous
Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely 
Demonstrates commitment to teamwork and cooperation 
Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
Qualifications:
Total of 2-5 years of experience in the US BPO/Healthcare industry
Bachelor's degree in Nursing with active US license of any state
Minimum 1-2 years of experience in a US Healthcare account (Utilization Management or Clinical Denial and Appeal and MCG is required)
Embrace change and think operationally to achieve business goals
Proven process improvement experience
We are accepting walk in applicants from 9AM - 5PM weekdays.