Denial Prevention Nurse Consultant

Our Company

Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We're powered by people, driven by technology, and dedicated to our clients and employees. If you're looking for a collaborative and diverse culture with a great work/life balance, look no further.

 

Why Revecore?

• We offer paid training and incentive plans
• Our medical, dental, vision, and life insurance benefits are available on day 1
• 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  

Primarily responsible for thorough review of medical records and other medical documentation to determine appropriate billable services for hospital to construct an appeal for payment based on medical necessity or payer specific guidelines or criteria. Responsible for providing clients trending, revenue cycle fail point analysis, and best practice remediation recommendations.

 

Responsibilities

• 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

 

Qualifications

• 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)

 

How we'll set you up for success:

• Extensive 90-day 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

 

Work at Home Requirements:

• A private, distraction-free environment to work from in your home
• On-Camera Presence: Being on camera is an essential part of our culture--it helps build trust, support collaboration, and strengthen team connections
• A secure internet connection
• Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads
• Revecore will provide you with your equipment - your workspace area must accommodate all workstation equipment (laptop, monitor, keyboard, mouse, docking station, and headset)
• Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check.

  
Revecore is an affirmative action-equal opportunity employer that does not discriminate based on race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status.

We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply.

Must reside in the United States within one of the states listed below:

Alabama, Arkansas, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia and Wisconsin 

 

 

Qualifications

Denial Prevention Nurse Consultant