Denial Prevention Nurse Consultant

• We offer paid training and incentive plans
• Our medical, dental, vision, and life insurance benefits are available from the first day of employment
• We enjoy excellent work/life balance
• Our Employee Resource Groups build community and foster a culture of belonging and inclusion
• We match 401(k) contributions
• We offer career growth opportunities
• We celebrate 12 paid holidays and generous paid time off  

• Build strong, lasting relationships with clients, payors and Revecore personnel
• Analyze medical records or other medical documentation to validate services, tests, supplies and drugs performed for accuracy related to billing for services rendered
• Identify and interpret medical, radiological, laboratory or other tests and procedures as well as pharmaceutical drugs
• Review and understand managed care contracts, hospital billing statements/bills and insurance denials
• Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims.
• Perform research regarding denials and effectively communicate information to associates, colleagues, managers and clients
• Contact insurance company to obtain missing information, explain and resolve underpayments and/or denials and arrange for payment or adjustment processing on behalf of client
• Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
• Perform denial trending for clients, identify fail points within the revenue cycle and on the payer side, and provide best practice recommendations to clients and Revecore managers.
• Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnel
• Maintain confidentiality of information in compliance with company policy and HIPAA
• Attend client, department and company meetings
• Lead client meetings and perform consulting services to client's as it relates to medical necessity of services performed and proper vetting of payers criteria

• College degree or diploma from school of nursing -- must be RN
• Clinical nursing experience working in hospital environment, preferably in ER, Critical Care or diagnostic services
• Minimum 5 years of related experience and/or training in utilization review or patient accounting
• Are highly proficient with Interqual and MCG guidelines and demonstrate appropriate application to claim appeal argument.
• Understand patient accounting documents -- UB04, EOB
• Have a working knowledge of Microsoft Office (Word, Excel, Outlook)
• Possess technical proficiency to work on multiple computer screens and software applications simultaneously
• Are able to read and interpret an extensive variety of documents such as medical records, patient care systems, instructions, policies and procedures in written (in English) and diagram form
• Can maintain strong performance in a fast-paced environment with productivity metrics
• Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies
• Have experience with healthcare billing software and databases (EPIC, Cerner, Meditech)

• Extensive multi-week training with ongoing support from teammates following training.
• Access to a robust knowledgebase for continued reference in your role.
• Visibility to your individual performance metrics enables you to set goals.
• Computers and necessary work equipment are provided 
• Involved management who leans in to support your productivity metrics.

• A quiet, distraction-free environment to work from in your home. 
• A secure internet connection is required. 
• Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. 
• The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive. 

Denial Prevention Nurse Consultant