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Overview

Coordinator-RAC TPE

Job Code: 21540

FLSA Status

Job Family: FINANCE

Job Summary

Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory requirements.

Job Responsibilities

+ Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors.

+ Educates department staff to issues related to the reimbursement process, as well as other concerns that result from monitoring activities.

+ Responsible for resolving issues as they occur.

+ Other duties as assigned.

Specifications

Experience

Description

Minimum Required: Required 2 years of healthcare care experience as RN

Preferred/Desired: PREFERRED 5 years of healthcare care experience and 3 years in Medicare billing environment. Previous audit experience, knowledge of InterQual and Medicare Billing practices.

Education

Description

Minimum Required: Diploma RN or RN AD

Preferred/Desired: BSN or RN with BS/BA in Business Administration or Management

Training

Description

Minimum Required: Successful demonstration and detailed understanding of Hospital Revenue Cycle, CPT codes, HCPC codes, modifiers, and the Medicare/Medicaid Appeals Process. Familiarity of billing regulations including federal and guidelines. Must have excellent communication skills and proven ability to present.

Preferred/Desired

Special Skills

Description

Minimum Required: Strong knowledge of state and federal healthcare laws and regulations. • Understanding of CMS coverage and payment methodologies

Preferred/Desired

Licensure

Description

Minimum Required: RN

Preferred/Desired:

Reporting Relationships

Does this position formally supervise employees? If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

Reporting Relationships: No

Work Environment

Functional Demands

Label Short Description Full Description

Sedentary Very light energy level Lift 10lbs. box overhead. Lift and carry 15lbs. Push/pull 20lbs. cart

Light Moderate energy level Lift and carry 25-35lbs. Push/pull 50-100lbs. (ie. empty bed, stretcher)

Medium High energy level Lift and carry 40-50lbs. Push/pull +/- 150-200lbs. (Patient on bed, stretcher) Lateral transfer 150-200lbs. (ie. Patient)

Heavy Very high energy level Lift over 50lbs. Carry 80lbs. a distance of 30 feet. Push/pull > 200lbs. (ie. Patient on bed, stretcher). Lateral transfer or max assist sit to stand transfer.

Functional Demands Rating: Sedentary

Physical Activity Requirements – Sitting: Continuous

Physical Activity Requirements – Standing: Frequent

Physical Activity Requirements – Walking: Occasional

Physical Activity Requirements - Climbing (e.g., stairs or ladders): Occasional

Physical Activity Requirements - Carry objects: Occasional

Physical Activity Requirements - Push/Pull: Occasional

Physical Activity Requirements – Twisting: Occasional

Physical Activity Requirements – Bending: Occasional

Physical Activity Requirements - Reaching Forward: Occasional

Physical Activity Requirements - Reaching Overhead: Not Anticipated

Physical Activity Requirements - Squat/Kneel/Crawl: Not Anticipated

Physical Activity Requirements - Wrist position deviation: Continuous

Physical Activity Requirements - Pinching/fine motor activities: Occasional

Physical Activity Requirements - Keyboard use/repetitive motion: Continuous

Physical Activity Requirements - Taste or smell: Not Anticipated

Physical Activity Requirements - Talk or hear: Continuous

Sensory Requirements

Color Discrimination: Yes

Near Vision: Accurate

Far Vision: Accurate

Depth Perception: Accurate

Hearing: Accurate

Environmental Requirements - Blood-Borne Pathogens: Not Anticipated

Environmental Requirements – Chemical: Not Anticipated

Environmental Requirements - Airborne Communicable Diseases: Not Anticipated

Environmental Requirements - Extreme Temperatures: Not Anticipated

Environmental Requirements – Radiation: Not Anticipated

Environmental Requirements - Uneven Surfaces or Elevations: Not Anticipated

Environmental Requirements - Extreme Noise Levels: Not Anticipated

Environmental Requirements - Dust/Particular Matter: Not Anticipated

Environmental Requirements - Other

REQNUMBER: 30860